key: cord-0693683-5v8oatxc
authors: nan
title: Abstracts for MASCC/ISOO Annual Meeting 2021
date: 2021-06-15
journal: Support Care Cancer
DOI: 10.1007/s00520-021-06285-8
sha: 0b676e9af8241fe57a41293905d71445745c7ce2
doc_id: 693683
cord_uid: 5v8oatxc

nan

Breakthrough Chemotherapy Induced Nausea and Vomiting(CINV) affects 30-50% of children receiving chemotherapy. We conducted an open label, single center, phase III randomized controlled trial in Chennai, India comparing the safety and efficacy of Olanzapine and Metoclopramide for treating breakthrough CINV Methods Children aged 5-18 years receiving moderately/highly emetogenic chemotherapy were screened for the trial. Primary prophylaxis was a combination of Fosaprepitant/aprepitant with Ondanseteron and Dexamethasone. Patients were randomly assigned to the metoclopramide or olanzapine arm only if they developed breakthrough CINV. Primary end-point was patients who achieved complete response (CR): no vomiting or retching or nausea for 72 hours after the administration Results Eighty patients were analyzed (39-olanzapine arm and 41metoclopramide arm). CR rates were significantly higher in the olanzapine arm compared to the metoclopramide arm for vomiting (72% vs. 39%, P<0.001) and nausea (59% vs. 34%, P=0.026). Seven(17%) patients in the metoclopramide arm crossed over to the olanzapine arm in view of persistent G III/IV vomiting after drug administration and none crossed over in the olanzapine arm (P<0.001). The mean nausea score in the olanzapine arm was significantly lower(P=0.01). Hyperglycemia and drowsiness were more commonly seen in the olanzapine arm Conclusions Olanzapine is superior to metoclopramide for treatment of breakthrough CINV in children. No serious adverse events were observed with olanzapine or metoclopramide Introduction While vomiting is well controlled with current anti-emetic regimens, unrelieved chemotherapy-induced nausea (CIN) is a significant clinical problem. Limited information is available on the mechanisms that underlie unrelieved CIN. The purpose of this study was to evaluate for perturbed biological pathways associated with endocytosis and apoptosis in oncology patients who did (n=399) and did not report CIN (n=310) prior to their second or third cycle of chemotherapy (CTX).

Oncology patients (n=735) completed study questionnaires in the week prior to their CTX treatment. CIN occurrence was evaluated using the Memorial Symptom Assessment Scale. Gene expression analyses 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 patients with and without CIN. We identified four perturbed pathways that are involved in endocytosis and apoptosis.

Our findings suggest that CTX-induced inflammation of the GI mucosa, that results in the initiation of endocytotic and apoptotic processes in the gut, is associated with the occurrence of CIN.

Introduction Chemotherapy-induced nausea and vomiting (CINV) is a preventable complication of cancer therapy that can negatively impact patient's life. Our aim is to assess complete response (CR) rate and quality of life as well as impact of guideline adherence on the patients' outcomes. Methods A prospective observational study was conducted from 2018 to 2019. Adult patients scheduled for chemotherapy were included. Multinational Association for Supportive Care in Cancer (MASCC) antiemetic tool (MAT) was used to record nausea and vomiting in acute (day 1) and delay phases (day 2-5) after initiation of chemotherapy. All patients completed functional living index-emesis (FLIE) questionnaire on day 6 to evaluate their CINV related quality of life.

The study included 100 patients. The mean age was 53 years, 50% were male.The emetic potential of chemotherapy regimens used were 27% high, 45% moderate, and 26% low. For the primary end points, 50% of patients achieved both CR and NIDL, 56% of patients achieved CR, and 71% achieved NIDL. Only 26% of patients received guidelineconsistent CINV prophylaxis. The most common reasons for guideline-inconsistent regimens were that antiemetic was not administered during multiday chemotherapy and not using Neurokinin 1 (NK1) receptor antagonists with high emetic potential regimens.

Data results demonstrated insufficient CR rate and NIDL among patients receiving chemotherapy regimens, and lack of guideline adherence for CINV prophylaxis.

Chemotherapy regimens used in autologous stem cell transplant for haematological malignancy are highly emetogenic, therefore guidelines recommend prophylactic use of NK-1 and 5HT3 antagonists with corticosteroid. No previous studies have investigated the superiority of combination NK-1/5HT3 preparations vs. separate NK-1+5HT3 antagonists used concurrently. Methods This retrospective comparative study examined the incidence of chemotherapy induced emesis in patients receiving combination preparation netupitant/palonosetron (n=19) vs. those given separate antagonists, ondansetron and aprepitant (n=57) in standard doses. Corticosteroid was administered alongside both regimens. The need for specialist palliative care input and relationship between chemotherapy dose and emesis were also examined.

Chemotherapy induced emesis was significantly less when using combination NK-1/5HT3 (50.0%) compared to separate NK-1+5HT3 preparations (82.5%), X2=6.56, p=0.01. Less Palliative care input was required for nausea & vomiting management in patients receiving combination preparations (5.5%) compared to separate antagonists (10%). No relationship between melphalan dose and incidence of nausea & vomiting was recognised, X2=3.68, p=0.45.

This retrospective trial suggests that combination netupitant/palonosetron is more efficacious in controlling chemotherapy induced nausea & vomiting in autologous stem cell transplant compared to ondansetron and aprepitant administered concurrently. Prospective randomised controlled trials should be considered.

The aim of this study was to review the efficacy, safety and costeffectiveness of olanzapine for the prophylaxis and rescue of CINV. Methods Ovid Medline, Embase and Cochrane were searched through April 30, 2020. Efficacy endpoints were the rate of complete response (CR), no nausea and no emesis, in the acute (0-24 h post-chemotherapy), delayed (24-120 h post-chemo) and overall (0-120 h post-chemo) phases. Safety endpoints were the rate of no serious adverse events. The Mantel-Haenszel random-effects analysis model was used to compute summary risk ratios. A decision tree model from a hospital perspective was constructed to evaluate cost and health outcomes for the prophylaxis of CINV following HEC. Results 3 and 22 studies reported on the prophylaxis and rescue of CINV, respectively. Following HEC, olanzapine was statistically and clinically superior in 7 of 9 efficacy endpoints in the prophylaxis setting; olanzapine also leads to lower total hospital cost. When olanzapine is administered at a 10-mg prophylactic dosage, it is statistically and clinically superior in 8 of 9 efficacy endpoints. Olanzapine may be effective in the MEC setting and when administered at 5-mg doses, but paucity of data leads to notable uncertainty.

Olanzapine is statistically, clinically and economically superior in the HEC setting for the prophylaxis of CINV. Further RCTs are needed in the setting of MEC patients and administration of olanzapine at a lower 5mg dose. 

International guidelines have recommended considering triple therapy with NK1-receptor antagonists (NK1-RA), 5HT3-receptor antagonists (5HT3-RA) and dexamethasone for oxaliplatin-containing regimens, a change from the previous recommendation of doublet therapy with 5HT3-RA/dexamethasone. Methods A single-centre retrospective analysis was performed, comparing the rates of breakthrough-CINV with day-1 triple-therapy prophylaxis versus historical control data in those receiving 5HT3-dexamethasone prophylaxis with FOLFOX chemotherapy. Patient data, treatment details and outcomes were extracted using Mosaiq®, an institutional electronic database. Significance of the association between two categorial variables was assessed by the Pearson Chi-Square Test. Results 64 patients underwent triple therapy between Mar 2018 -Jan 2019, and 147 patients received 5-HT3-dexamethasone with FOLFOX between Jan 2016 -Mar 2018 ( Table 1 ). The incidence of nausea was significantly reduced in those receiving upfront triple therapy (67.2%) vs those receiving doublet therapy (91.8%), p < 0.001 ( Table 2 ). The incidence of emesis was significantly reduced in those receiving upfront triple therapy (6.3%) vs those receiving doublet therapy (21.8%), p 0.002 (Table 3 ). The median cycle of maximum nausea & vomiting was significantly delayed in those receiving upfront triple therapy (Tables 2&3). Conclusions Upfront triple therapy was associated with a significantly reduced incidence of CINV in patients receiving FOLFOX when compared with traditional doublet therapy.

The PI3K/Akt/mTOR signaling is over-activated in cancers with Akt being pivotal for multiples processes in tumorigenesis. Targeting Akt is an appealing anti-cancer strategy and Akt inhibitors are in clinical development. Use of such inhibitors evokes vomiting. The aim of this study is to decipher the role of Akt in emesis. Methods Shrews were injected with incremental doses of direct (perifosine or pyrvinium) or indirect (rapamycin or temsirolimus) Akt inhibitors and observed for 30 minutes for vomiting.

Relative to vehicle control, perifosine caused significant frequency of vomits (50 mg/kg) by 50% and 90% at its 20 (P<0.05) and 50 mg/kg (P<0.0005) doses. Combination of non-emetic doses of perifosine (10 mg/kg) and the NK1 receptor agonist GR73632 (1 mg/kg), produced significant increases in vomit frequency (P = 0.01) and the percentage of shews vomiting by 75.00% relative to either perifosine (P = 0.01) or GR73632 alone (P = 0.02). Pyrvinium also produced dose-dependent increases in vomit frequency (P = 0.054) and the percentage of shrews vomiting (50%) at its 5 mg/kg dose (P = 0.02). Likewise, rapamycin produced increases in vomit frequency (P = 0.054) and number of shrews vomiting (80%, P = 0.02) at its 10 mg/kg dose, whereas temsirolimus increased these parameters at its 2.5 (57%, P = 0.04), 5 (78%, P = 0.005), and 10 mg/kg (100%, P = 0.001).

Our findings provide evidence of an emetic role for Akt inhibitors. We postulate that Akt protein inhibition causes over activity of its downstream pro-emetic targets.

CHEMOTHERAPY-INDUCED NAUSEA AND VOMITING IN BREAST CANCER.

Patient expectations are a known predictor of chemotherapy-induced nausea and vomiting (CINV) but their role must be confirmed and clarified next to other factors. Methods A bride range of factors previously related to CINV was studied in 157 outpatients receiving chemotherapy (CT). Patients' expectations for CINV were one of them and were measured with a 5-point Likert scale from 1 ("I definitely will not have this") to 5 ("I definitely will have this"). Each factor was analyzed by simple logistic regression (SLR) and the Introduction Despite the use of newer antiemetics, chemotherapy-induced nausea and vomiting (CINV) is reported by up to 70% of adult patients receiving highly emetogenic chemotherapy agents. The present study was done to compare aprepitant (APD) vs Olanzapine (OPD) in terms of efficacy in emesis control, cost and quality of life.

The study was conducted in patients receiving highly emetogenic chemotherapy from September 2019 to September 2020.Patients were randomized to 2 groups (APD vs. OPD). Data about nausea and vomiting was collected for the first 5 days post chemotherapy and comparison analyses was done using the chi square test. Quality of life assessment was done using the FLIE questionnaire. Results A total of 120 patients were studied ,60 in each group. Complete response with aprepitant in acute, delayed and overall phase are 78%,82% and 75% respectively and with olanzapine the CR rates are 85%,82% and 77% respectively. Nausea control rates in acute and overall phases were similar between the two groups. In delayed phase 62% in APD group and 83% in OPD group didn't have nausea(p=0.025). Around 80 % patients in both arms had no impact on daily living in both arms due to CINV.

Olanzapine is superior to aprepitant in terms of delayed nausea control. Olanzapine is an equally efficacious and cheaper alternative to aprepitant in controlling chemotherapy induced nausea and vomiting in patients receiving highly emetogenic chemotherapy. 

Carboplatin is moderately to highly emetogenic depending on the dose. Olanzapine has an equivalent antiemetic effect as aprepitant and is superior at controlling nausea for highly emetogenic chemotherapy. We evaluated the efficacy and safety of low dose olanzapine (5mg/day) with doublet therapy for carboplatin-induced nausea and vomiting in patients with thoracic malignancies. Methods Patients who received a carboplatin (AUC ≥ 5)-based regimen and had never been administered moderate or high emetogenic chemotherapy were eligible. All patients received olanzapine (5 mg po daily on days 1-4, after dinner) in combination with granisetoron and dexamethasone. The primary endpoint was complete response (CR: defined as no emesis and no use of rescue medication) rate during the overall period (0-120 hours). A total of 48 patients were required to detect a 15% improvement in CR from 65% to 80% with a one-sided type I error of 0.1 and 80% power.

Between February 2018 and June 2020, 51 patients were enrolled. 50 patients who met criteria were included in efficacy and safety analysis. The CR rate in the overall phase was 94.0% (80% CI, Introduction CBDCA is ranked as the highest CINV risk of the moderately emetogenic chemotherapy agents and was recommended as triplet antiemetic treatment. However, there remains an unmet clinical need for the control of CINV, especially patients with risk factors such as female sex and younger age which increases CINV. We conducted a phase II study to evaluate of the efficacy and safety of 5 mg olanzapine (OLZ) combined with standard triplet therapy to prevent CBDCA-induced nausea and vomiting in gynecologic cancer patients. Methods All patients received OLZ 5 mg in combination with aprepitant, granisetoron, and dexamethasone. The primary endpoint was complete response (CR) rate, as no emetic episodes and no use of rescue medications during the overall period (0-120 hours). A total of 60 patients were required to detect a 15% improvement in CR from 60% to 75% with a one-sided type I error of 0.1 and 80% power.

A total of 60 patients were enrolled. The 57 patients who met the criteria were included in efficacy and safety analysis. The CR rate for the overall phase was 78.9% (80% CI: 70. 4-85.9 ). Acute (0-24 hours) and delayed phase (24-120 hours) were 96.5% and 80.7%, respectively. There were no grade 3 or 4 toxicities related with OLZ. Conclusions OLZ 5 mg combined with standard triplet therapy has promising activity with manageable safety. It's suggesting that it can be considered a new standard antiemetic therapy in patients receiving CBDCA-based chemotherapy.

Chemotherapy-induced nausea and vomiting (CINV) is an important problem to be resolved. The effect of acupuncture on CINV is still controversial.

Patients who received high emetogenic chemotherapy were randomized to receive either group A; standard antiemetics (aprepitant, ramosetron, metoclopramide, dexamethasone) plus acupuncture (Group A) or standard antiemetics only (Group S). The manual stimulation was applied at one side PC6, LI4, ST36 and LR3, Tonification method of Spleen meridian or Purgation method of Stomach meridian (total 8 acupoints). The emesis (nausea and vomiting) was assessed by RINVR and MASCC antiemesis tool. Primary endpoint was the score of delayed nausea assessed by RINVR. Results A total of forty two patients were included in the analysis. There was lower but no significant difference in Group A compared to Group S (score 5. 35 vs 5.98, p=0.3011) . However, if we assessed the delayed nausea by MAT, Group A showed significant relief compared to Group S (score 2.48 vs 4.33, p=0.0361). In the analysis using RINVR score, there were not significant but a trend of decreased score in terms of delayed emesis (Group A vs S: 8.53 vs 8.57, p=0.9703). In the analysis using MAT, Group A showed significant improved score of delayed emesis compared Group S (score 2.52 vs 4.90, p=0.0275). There was no significant difference in acute emesis between the two groups. Conclusions Acupuncture tended to reduce delayed nausea. Espicially when evaluated with the MAT tool, delayed emesis was significantly improved with acupuncture. Introduction 5-HT3 receptor antagonists are used to control chemotherapy-induced nausea and vomiting (CINV). Although single nucleotide polymorphisms (SNPs) of 5-HT3 receptor subunit genes are known, their functions have been still unclear. We hypothesized the SNPs influenced on the antiemetic effect of palonosetron and performed a prospective study in malignant lymphoma patients treated with the CHOP regimen. Methods Palonosetron was administered intravenously at 0.75 mg, 30 min before the CHOP regimen. Fifty samples of genomic DNA were extracted before initial treatment and preserved at −80°C until analysis. We performed PCR assay of the five polymorphisms in the 5-HT3 receptor genes: HTR3A rs1062613, HTR3B rs1176744 and rs35312182, HTR3C rs6766410, and HTR3D rs6443930. Sequencing analysis of del AAG (rs35312182) was performed via PCR amplification of genomic DNA. We defined a complete response (CR) as no vomiting and abstaining from the use of rescue antiemetic drugs. The associations between the frequency of each SNP and acute, delayed, and overall period of CR rate were evaluated.

The characteristics of each SNPs were shown in Table1. Correlational analysis revealed that G allele carriers of rs1176744 were associated with lower CR rate (66.7%) in acute emesis than T/T homozygosity (93.1%) (p = 0.0253, Table 2 ).

Patients harboring the G allele in rs1176744 (HTR3B) may present CINV more frequently than those with wild type and need more intensive antiemetic therapy.

In a randomized, double-blind, placebo-controlled trial, we reported the efficacy of 5 mg olanzapine (OLZ) + triplet antiemetic therapy for nausea and vomiting induced by cisplatin (CDDP) in the delayed phase (24-120 h). We herein report the results of a pre-planned subgroup analysis according to patient-related risk factors. Methods Subgroup analysis was performed on a complete response (CR: no emesis and rescue medication) in the delayed phase and time to treatment failure (TTF: time from CDDP treatment to the first vomiting or use of rescue therapy). Data from 705 patients in the efficacy analysis population were analyzed according to drinking habits, or having motion sickness or pregnancy-related sickness.

Risk difference for a CR in the delayed phase was significantly greater for OLZ than placebo (PLA) patients with (14.9%, p = 0.001) or without (12.0%, p = 0.014) a drinking habit, without motion sickness (13.9%, p < 0.001), or with pregnancy-related sickness (27.2%, p = 0.002). TTF was significantly longer for OLZ than PLA patients with (hazard ratio [HR] 0.437, p < 0.001) or without (HR 0.613, p = 0.007) a drinking habit, without motion sickness (HR 0.478, p < 0 .001), or with pregnancy-related sickness (HR 0.431, p = 0.001).

Our results suggest a benefit for 5 mg OLZ + triplet therapy in patients after CDDP treatment, with/without a drinking habit, who do not experience motion sickness or who experience pregnancyrelated sickness.

Duration of breakthrough CINV (ie, treatment failure (TF); emesis/rescue use) was previously explored in a Phase 3 study showing that extended duration TF (xTF, ≥3 days) is a stronger predictor for TF in future cycles than shorter TF (sTF, 1-2 days) . In this non-interventional registry, we explored whether 1) TF in cycle 1 (TF1) led to TF in cycle 2, 2) xTF in cycle 1 (xTF1) recurred in cycle 2, and 3) xTF rates differed between aprepitant + 5HT3 and NEPA (fixed combination of netupitant/ palonosetron). Methods NERO was a prospective, observational, multicenter, international study designed to assess complete response (CR: no emesis/no rescue) rates in pts receiving guideline-consistent versus -inconsistent antiemetic prophylaxis as a primary objective. This post-hoc analysis included only pts who received a guideline-based NK1 receptor antagonist-containing regimen prior to highly emetogenic chemotherapy (HEC) or carboplatin for 2 cycles. CINV in cycles 1 and 2 was tabulated, with duration categorized as sTF and xTF. Pearson's chi-square test was used to evaluate differences between cycles and/or treatments.

Of 221 pts, most (80%) with initial TF repeated TF in the next cycle. Of repeaters, duration was consistent for 68% (xTF) and 77% (sTF) of pts. Pts receiving NEPA had less xTF than pts receiving APR. (Table) Conclusions Analysis of this "real-life" study confirmed that initial CINV is highly likely to recur in cycle 2 and with the same duration seen in cycle 1. NEPA appears to prevent extended CINV to a greater extent than aprepitant.

Chemotherapy induced nausea and vomiting (CINV) continues to be a distressing side effect of paediatric cancer treatment. It is estimated that 70%-80% of patients experience nausea and vomiting. Successful control of CINV upfront is vital, complete control during the acute phase reduces the incidence of CINV in the delayed phase and importantly is associated with reduced incidence in subsequent chemotherapy cycles. Internationally, significant changes have been made to CINV prevention guidelines. Compliance with these recommendations represents a major challenge in improving CINV outcomes in children with cancer. With new evidence supporting the use of NK1 antagonists, newer 5HT-3 antagonists and options for breakthrough CINV in children, these recommendations need to be explored for appropriateness of implementation at a local level. Methods A literature review was undertaken to identify studies that evaluated antiemetics for prevention of CINV in paediatric oncology patients with a focus on new agents and publications in the last 5 years.

Recent guidelines make recommendations for the use of antiemetics according to the emetic potential of the chemotherapy. NK1 antagonist aprepitant and 5HT-3 antagonist palonosetron are included in these guidelines for prevention of acute nausea and vomiting. Atypical

The purpose of this study was to explore the association of genetic biomarkers as common data elements (CDE's) with self-reported symptoms including nausea, vomiting, pain, fatigue, sleep disturbance, anxiety, and quality of life. Methods Following informed consent, women aged 18-90 were recruited prior to surgery and followed for one year. Symptom data were collected using the Patient-Reported Outcome Measurement Information System (PROMIS)29, the PROMISGI, and an 11 point verbal pain scale. Genotype data were collected from DNA extracted from saliva.

The sample consisted of 200 women aged 59.9 years. Minor allele frequency for all polymorphisms was at least 25%. Genes that showed an association with nausea included BDNF, COMT, and SLCA4. Women who were homozygous for the CC genotype of BDNF rs6265 reported more nausea than those women with a least one minor allele (p<0.02). The AA genotype of the Val158/Met polymorphism of the COMT gene was significant for higher levels of pain (p=0.006) compared to the heterozygous AG or the homozygous GG genotype. Nausea followed the same pattern but was not statistically significant.

The use of functional polymorphisms as common data elements in symptom science coupled with standardized patient self-reporting tools will increase the ability to collaborate, resulting in larger data sets, greater generalizability, and provide support for effective translation into clinical practice.

We aimed to investigate the current status and features of patient selfdetermination after implementation of the Life-Sustaining Treatment Decisions Act in Korea.

Between February 2018 and January 2019, 54,635 cancer deaths were identified from the National Health Insurance Service database. We analyzed the characteristics of decedents who complied with the law process by self-determination compared with decedents with family determination and with decedents who did not comply with the law process.

In multivariable analysis, patients with self-determination were younger, were less likely to live in rural areas, were less likely to be treated in general hospitals, and were more likely to show a longer time from cancer diagnosis compared with patients with family determination. Compared with patients who did not comply with the law process, patients with selfdetermination were younger, lived in Seoul or capital area, were treated in general hospitals, were less likely to have genitourinary or hematologic malignancies, scored higher on the Charlson comorbidity index, and showed a longer time from cancer diagnosis. Patients with selfdetermination were much more likely to use hospice and less likely to use intensive care units (ICUs) at the end-of-life (EOL).

Decedents with self-determination were more likely to be younger, reside in the Seoul or capital area, and show a longer time from cancer diagnosis. These patients utilized hospice more frequently, and received less ICU care at the EOL.

In patients with AC, the balance between active anticancer therapy (AACT) and optimal quality of life (QoL) is a controversial issue. Medical oncologists (MO) tend to prescribe AACT until the last weeks of life, sometimes in patients with serious deterioration of their general conditions. Giving a "status": "do not resuscitate" (DNR) or "best supportive care" (BSC) can help avoid such situations. However, this is not done consistently in current oncological practice and leads to conflicting situations.

We reviewed retrospectively 15 consecutive patients, among 272, admitted to our Supportive Care Unit between July 2018 and February 2019, for management of severe symptoms and in whom there was a disagreement between the supportive care physician (SCP) and the MO about a therapeutic limitation decision (DNR or BSC) . A discussion of possible reasons for the disagreement was organized between the MO and SCP.

The table shows the modifications in terms of status after the consultation between the MO and SCP. The status was changed from "no status" to "BSC" in 11/15 (73%) patients. The median time for the change of status was 8 days and the median survival after the change was 9 days. Only 6 (54%) of the patients were involved in the change of status.

Patients with AC are often managed without a plan for a therapeutic limitation decision, with the risk of overtreatment and poor QoL. A consensual approach between caregivers, and involvement of the patients, might help to clarify these issues.

Ethical dilemmas in the end-of-life process are widely described in the literature, but its magnitude in real clinical practice is not yet known. The objective of this study is to determine its prevalence in patients with advanced cancer. Methods Cross-sectional, prospective, observational, multicenter and multilevel study (Hospital, Primary Care, Hospice), which consecutively included advanced cancer patients, ≥18 years, with a life expectancy ≤6 months and informed consent. A multidimensional evaluation described the patientś characteristics. The main outcome variable was the presence of ethical dilemma (problem in decision making that includes the need to choose between different options associated with moral values, opposed to each other, where none is clearly preferable) Results A total of 324 patients were included, 58% were men and their mean age was 69 years. In 90 patients (28%) was observed 117 ethical dilemmas: conflicts about information 51 (16%); disagreement in therapeutic proportionality 54 (17%); research conflicts 8 (2%); request for euthanasia or assisted suicide 4 (1.2%). Prevalence was significantly higher in male patients, undergoing active cancer treatment, and with emotional distress (p <0.05). Conclusions A high prevalence of ethical dilemmas was observed in advanced cancer patients, mainly associated to communication conflicts and disagreement on therapeutic proportionality. Male patients, in course of cancer treatment or with psychological distress are more likely to present ethical dilemmas.

The aim of this study was to investigate of roles and competency lifesustaining treatment (LST) coordinators in South Korea after Lifesustaining Treatment Decisions Act in 2018.

Semi-structured, face-to-face interviews were conducted with 11 LST coordinators to address the research aims and objectives. Face-to-face semi-structured interviews were used to collect data over a 15-month period, which were then thoroughly transcribed and analyzed using the Graneheim & Lundman qualitative content analysis approach.

Nurses made up 90% of the LST coordinators. The position of the LST coordinator was similar to that of a clinical ethics consultation in terms of deliberation, consultation, education, administration, and statistics, but it was only for life-sustaining care in South Korea. Except for a few clinical divisions, LST coordinators assumed physicians had little interest in life-sustaining treatment. The competencies the LST coordinators must have are a theoretical foundation for making sound decisions, as well as clinical expertise, legal knowledge about LST, counseling, administrative and statistics training. The LST coordinators must be able to comprehend the family background as well as make surrogate decisions in order to build a strong family-oriented Confucian culture.

The LST coordinator's position is vital to the rapid settlement of the LST Decisions Act. LST coordinators develop practical abilities to understand family culture, law, and clinical circumstances in order to allow patients to end their lives with dignity 

There are no definitive guidelines for Bone mineral density (BMD) monitoring and treatment with bone modifying agents during cytotoxic chemotherapy in breast cancer patients. Methods Fifty postmenopausal women with non-metastatic breast cancer planned for sequential anthracycline and taxane-based chemotherapy were prospectively enrolled during the study period . BMD at lumbar spine, femur's neck, and total hip were assessed by DXA scan. Bone turnover markers (BTM) and regulatory markers were evaluated at baseline and end of the 7th cycles. The differences in BMD levels, BTM markers, and Quality of life (Qualeffo-31) were analyzed by paired ttest or Wilcoxon signed-rank test.

The median age of the study group was 53.6 (42-65) years. The mean percentage fall in BMD at the lumbar spine, total hip, and neck of the femur were -3.0 ± 2.7, -2.5 ± 2.4, and -3.0 ± 4.0, (P< 0.001) respectively. The median risk of osteoporotic fracture at 10 years (FRAX score) increased from 1.9(1.5) % to 2.1(1.4) % (P=0.001). The P1NP/CTX ratio significantly decreased at the end of chemotherapy (121.0±57.7) as compared with baseline (166.7±81.6) (P<0.001), indicating accelerated bone resorption. There was no significant change in the RANKL/OPG ratio, Vitamin D, iPTH, BALP and P1NP during chemotherapy. There was a Introduction Aromatase Inhibitor (AI) therapy and androgen deprivation therapy (ADT) often results in rapid bone loss and increased fractures. Vitamin D (VITD) protects against bone loss but it is unclear if the recommended daily allowance (RDA:600 IU/day) of VITD is sufficient for cancer patients. This RCT aimed to test the safety and efficacy of high-dose VITD supplementation on bone mineral density (BMD) compared to the RDA. Methods 164 breast and prostate cancer patients on AIs and ADT, respectively, with low VITD (<32 ng/ml) were randomized to either: 1) high-dose VITD (50,000 IU/week; n=99) or 2) placebo (n=65) for 24 weeks. All subjects received the RDA of VITD 600 IU/day. Serum VITD and calcium were assessed at baseline, weeks 6, 12, 18, and 24 . BMD was assessed at the hip via DXA at baseline and week 24. Results  Fig 1 and 2 show the change in serum VITD and calcium, respectively, over 24 weeks. There was a significant between-group difference in change of total hip BMD (high-dose VITD:−0.8% vs placebo:−2.6%; p<0.01). Larger differences were noted for those with lower baseline VITD levels (<27ng/ml) for both total hip (high-dose VITD:−0.6% vs placebo:−3.2%; p<0.001) and femoral neck (high-dose VITD:+0.2% vs placebo:−2.4%; p=0.03).

Immunotherapy with programmed cell death inhibitors (PD-1 inhibitors) have revolutionized the treatment of metastatic cancer. We present 2 cases of biopsy proven bone metastasis with complete response from these treatments.

We retrospectively identified patients who had surgery or bone biopsy and were treated with PD-1 inhibitors over the past year., who had complete response from immunotherapy treatment on follow-up scans.

Two cases were identified with the criteria. Case one: 53 year old middle eastern male with metastatic urothelial cancer with metastasis to right humerus, he had biopsy of this lesion consistent with metastatic urothelial cancer. he was treated with atezolizumab for 2 years. after 2 years there was complete disappearance of bone lesion both on bone scan and MRI. Case 2, 56 year old Caucasian male with right tonsil, squamous cancer, had right tonsillectomy and selective neck dissection followed by radiation to the neck. 2 years later, he had back pain. he was found 2 have 3 bone lesions -T11, L4-5, lumbar laminectomy was done followed by radiation. surgical pathology confirmed that this was metastatic squamous cancer from the tonsil. This was followed by treatment with pembrolizumab for 2 years. latest follow-up showed complete response of the bone lesions. Conclusion: complete remissions and cure is possible in patients with metastatic cancer to the bone treated with PD-1 inhibitors and PDL-1 inhibitors. immunotherapy can cure patients with oligometastasis to the bone which were incurable in the past.

Pharmacological pain management for cancer patients may not always achieve the desired outcomes and may be associated with significant side effects. The goal of the Cannabis Pilot Project (CPP) was to evaluate the feasibility and effectiveness of medical cannabis (MC) as a therapeutic tool in supportive cancer care. This study reports on the effects of MC on total medication burden (TMB) and pain management in cancer patients. Methods Forty consecutive cancer patients from the CPP at the Cedars Cancer Centre of the McGill University Health Centre were assessed for concomitant medications and the Brief Pain Inventory (BPI) questionnaire at the initial and two follow-up visits (FUP) . TMB was determined using the Medication Quantification Scale (MQS), which quantifies the potential for acute or chronic side effects (detriment weight) and the dosage (dosage score) for each medication.

In our cohort (61.3±13.3 y, 55% male), breast, colorectal and lung cancers accounted for 43% of diagnoses. Mean MQS scores decreased from 13.1±9.7 at baseline to 11.0±9.2 (p<0.01) at FUP1 (after 1 month), then to 10.9±8.9 (p<0.01) at FUP2 (after 2-3 months) ( Figure 1 ). The BPI "worst possible pain" score improved from baseline across both FUPs (5.4 ±2.7 at baseline, 4.7±2.7 at FUP1, 4. 0±3.0 at FUP2, p<0.05). In addition, the BPI "average pain" score improved from baseline across both FUPs (4.3±2.3 at baseline, 3.5±2.5 at FUP1, 3.0±2.3 at FUP2, p<0.05) ( Table 1) .

Our study supports an important role for MC on TMB and pain control in cancer patients.

Breast cancer patients receiving radiotherapy (RT) commonly report pain, contributing to physical and emotional distress, potentially leading to lower quality of life. This study prospectively identified trends and risk factors in patient-reported pain associated with breast irradiation using the Edmonton Symptom Assessment Scale (ESAS) and study-specific Skin Symptom Assessment (SSA). Methods Patients completed the ESAS and SSA at baseline (before RT), once a week during RT and up to 6 weeks after completion of RT, and 1-3 months post-RT. Patients who completed at least one assessment at each time point were included in the study. Results 426 patients were included for analysis. Overall pain increased significantly from baseline at weeks 1-2, week 5, and at 1-3 months post-RT (Table 1 ; p<0.001). Breast pain specifically increased significantly at weeks 1 and 2 (p<0.001) post-RT compared to baseline. Previous chemotherapy in mastectomy patients was associated with increased overall pain compared to mastectomy patients without previous chemotherapy ( Table 2 ; p=0.017). Younger patients (40-49 or 50-59 years of age) reported more overall pain (Table 3 ; p=0.038) and breast pain (p=0.0038) compared to patients ≥60 years of age. Conclusions Patient-reported pain associated with breast irradiation peaked 1 week after RT completion. These results provide support for closer monitoring of acute pain associated with breast RT in younger patients.

This trial aimed to evaluate the effectiveness and cost-effectiveness of a suite of cancer pain guideline implementation resources designed to improve pain outcomes for patients. Methods A stepped-wedge cluster randomised controlled trial. Australian patients with cancer pain ≥ 5 Numerical Rating Scale (NRS) were recruited from 8 ambulatory oncology and palliative care services ('clusters'). During the control phase, services routinely screening patients for pain.The intervention consisted of tailored implementation strategies in accordance with their service's needs.The trial's primary outcome was percentage of patients with 30% reduction in worst pain NRS one week after presenting with pain ≥5 NRS. Secondary outcomes, included quality of life, carer experience, and cost-effectiveness.

Out of 8743 patients screened, 754 consented with 329 randomised to the intervention and 425 to the control. The observed effect was less that hypothesized: Adjusted Odd p=0.59) . Mean average pain improved by ≥0.5 standard deviation at all time points in both arms. Mean worst pain improved by ≥0.5 standard deviation at week 1 for those with pain NRS ≥5 but not at other time points or for patients with worst pain NRS 2-4 at Week 1.

Achieving better pain management outcomes in cancer clinical practice is challenging. This presentation will report on the study and the insights and lessons learnt from this large clinical trial and the recommendations for future research in this area.

Levorphanol, a potent opioid and NMDA receptor blocker with minimal drug interactions, has not been studied in cancer patients. We aimed to determine the frequency of successful opioid rotation (OR) to levorphanol and the median opioid rotation ratio (ORR) from Morphine Equivalent Daily Dose (MEDD) . Methods This is a prospective, single-group, interventional study. Cancer outpatients requiring an OR and receiving a MEDD of 60-300 mg were rotated to levorphanol using a ratio of 10:1 and assessed daily for 10-days. Successful OR was defined as a 2-point improvement in Edmonton Symptom Assessment System (ESAS) pain score on day 10 or achieving the personalized pain goal between day 3-10. The ORR to levorphanol was calculated using net-MEDD (MEDD before OR minus the MEDD of the breakthrough opioid used along with levorphanol after OR). Results 40 patients underwent OR to levorphanol, and uncontrolled pain 35/40 (87.5%) was the most common indication ( Table 1 ). The median net-MEDD and levorphanol doses were 95 and 10 mg, respectively, and 33/ 40 (82.5%) had a successful OR with a median (IQR) ORR of 8.5 (7.5-10). Successful OR was associated with significant improvement in ESAS symptom scores and opioid side effect scale (Table 2 ). There was a strong association between MEDD and the daily dose of levorphanol (figure 1).

This study provided preliminary data that a majority of cancer patients could be successfully rotated to levorphanol using an ORR of 8.5.

Palliative radiotherapy is an effective treatment modality for pain palliation in bone metastasis. Single and multiple fraction radiotherapy treatment schedules are equally efficacious in pain palliation, however they differ in re-irradiation rates, treatment cost and radiotherapy machine time.

Methods Case records and radiotherapy treatment charts of patients who underwent palliative radiotherapy for painful bone metastasis in our department between June 2017 to May 2019 were reviewed and data was analysed using SPSS software.

Total number of patients -130. Mean age -57 years (25-79). M:F -1.13:1. The most common site of primary disease was lung (38.5%) followed by breast (27.7%) and bone metastatic site was dorsal spine (24.5%) followed by pelvis (21.9%) and lumbar spine (21.5%). Common RT schedules -30Gy/10# (36.9%), 20Gy/10#(28.8%) and 8Gy/1# (25%). During follow up (<40% patients), re-irradiation rates were almost similar between single and multiple fractionation. Average time taken to treat one lesion/fraction~2.6mins. Therefore, time spent to treat 62 lesions in ECOG PS 3/4 patients (20%) -995.8mins, same if treated by single fraction -161.2mins. Treatment cost was 1/3rd less with 1# RT due to reduced fractions, hospital stay, travel and personal expenses.

Single fraction palliative radiotherapy with reduced radiotherapy machine load and better resource allocation can be considered as a cost effective Importance Naloxone, a short-acting opioid antagonist, can reverse opioid overdose (OD) and save lives. Provider hesitancy due to lack of awareness and adequate education is a known barrier to prescribing take-home naloxone (THN) . We aimed to measure the impact of provider education on new THN prescriptions among high-risk cancer outpatients receiving opioids.

In January 2020, our supportive care team initiated a 1 month provider education program to include a twice-weekly short video presentation and pamphlets displayed in the clinic work areas highlighting the risk factors (RF) for ODs (Table 1 ) among our patients. Patients with 1 or more RF are considered qualified for THN. We retrospectively reviewed the electronic health records of 200 randomly selected patient visits each during the 2 months before the education, the month of education, and 2 months after the education. Data regarding RFs and THN prescriptions were collected.

The median age was 61 y, 54% were female, and 70% white. 84%, 77%, and 76% have RF for ODs before, during, and after the educational period. Of these, 8% vs 12% vs 4% received new THN prescriptions (P=0.01).

The provider educational program was associated with a statistically significant increase in THN prescription rates during the intervention, but the effect was not sustained 2 months after. Further research must focus on other strategies to educate providers and sustain its effect in coprescribing THN to high-risk patients receiving opioids.

1. Morphine milligram equivalent dose (MEDD) >100mg 2. Methadone use 3. Concurrent use of benzodiazepines, Barbiturates, Carisoprodol 4. Concurrent use of gabapenƟn >= 900 mg or Pregabalin>=150mg 5. History of substance use disorder 6. Previous history of opioid overdose 7. History of incarceraƟon 8. Chronic Respiratory diseases (Ex: COPD, Asthma. Including Sleep Apnea, Requiring home O2) 9. Chronic renal or hepaƟc disorder (eGFR < 60 and elevaƟon of AST, ALT, or total bilirubin to more than twice the listed normal value). 10. All high-risk paƟents idenƟfied by posiƟve scores on screening tools such as ( 1 CAGE-AID +ve, 2 SOAPP +ve, 3 CHAT PaƟents/non-medical opioid use behaviors)

Pain is the worst symptom for advanced Oral Squamous Cell Carcinoma(OSCC) patients at diagnosis and following surgery. This study aimed to assess the adequacy of pain management prior to and in the first month following surgery in stage III and IV OSCC patients undergoing surgery. Methods A prospective cohort of 30 stage III and IV OSCC patients undergoing primary oral cancer surgery at Dental Teaching Hospital Peradeniya, Sri Lanka were included. Brief Pain Inventory Short Form(BPI-SF) worst pain severity(BPI-W) and analgesics prescriptions were recorded on the day before surgery(T0) and at 7(T1), 14(T2) and 30(T3) days post-operatively. Adequacy of pain management was computed using Pain Management Index(PMI) for each time point.

The prevalence of pain was 96.7% at T0, 100% at T1 and T2 and 96.7% at T3. Moderate to severe BPI-W score was reported in 48.3%, 86.7%, 56.7% and 58.6% at the same time-points and mean(SD) of BPI-W scores were 4.57(2.30), 6.27(1.96), 4.83(2.42 ) and 4.93 (2.70) respectively. Nearly 60% at T0, T1 and 70% at T2 reported adequate pain control (PMI ≥0) while 65.6% had(-ve) PMI at T3. PMI reported at different time points were significantly different (Friedman's test, χ2 (3) = 11.16, P < 0.05) with a significant difference in PMI from post-op 14-days (Median = 0.00) to 30-days (Median = -1.0) (P<0.05) (Post-Hoc with Bonferroni adjustment).

Pain management was inadequate approximately in one-third of patients prior to and until post-operative 2nd-week, and in two-thirds of patients following one-month post operatively.

Palliative RT accounts for 35-40% of the RT department's workload. Historically patients had a wait for a CCO for pain symptom RT1. RT is effective in managing painful bone metastases even in the last 12 weeks of life3. Literature suggests various response rates: 60-90% for pain management from bone metastases2. Data from our own service shows an overall improvement of 71%. Methods A service for rapid access to palliative RT to improve the patient experience with timely access for symptom control has been developed. Patients are seen by a CR, assessed for suitability for palliative RT, consented, referred and radiation prescriptions completed eliminating waiting times for CCO clinics. The CR offers an outreach service to local Hospices ensuring patients receive timely assessment and treatment as appropriate.

The streamlined process has reduced referral times. Other healthcare professionals contact the CR for advice and direct referrals. Pain is managed in a timely manner and palliative RT demonstrates a reduction of pill burden, length of stay and acute admissions. Analysis of 75 patients shows reduction in the referral pathway length for patients managed by the CR rather than CCO. Average time from referral to seen -CCO 13 days v CR 2 days.

Although there are still many challenges to overcome, management of the palliative pathway by a CR improves patient access to timely symptom control.

Conflicting views exist for transdermal fentanyl (TDF) dose conversions.

Recommendations range from 5 mg of oral morphine to 1 mcg/hr of TDF (5:1) to 2 mg of oral morphine to 1 mcg/hr of TDF (2:1). We hypothesized that dose escalations would be an effective marker to show uncontrolled pain and that dose escalations occur more often with conservative dose conversions (>3:1).

Adult oncology patients (pts) who filled TDF at Vanderbilt pharmacy from 7/2017 to 7/2019 were screened. Exclusion criteria included previous TDF use and no follow-up within 30 days. A retrospective chart review was conducted to assess the initial 30 days on TDF. The primary outcome was dose escalation within 30 days. Secondary outcomes included adverse drug events (ADE), pain scores, and provider specialty.

Of the pts (n = 297) screened, 97 pts were included. Dose escalations occurred in 55.6% of pts (n = 27) using ≤3:1 ratio, and 54.2% of pts (n = 70) using a >3:1 ratio (Table 1) . Pain scores at D30 were lower with aggressive dose conversions when adjusting for initial pain score ( Table 2 ). There was a similar rate of ADE between both groups (12% with ≤3:1 ratio vs. 20% with >3:1; P = 0.3). Palliative care was more likely to use aggressive dose conversions compared to other specialties ( 

Pain, depression and anxiety decrease quality of life in cancer patients. Duloxetine is preferred for neuropathic pain (NP), however NP is challenging to treat and opioids are often co-prescribed. Methadone is an opioid used for both cancer and NP. Based on overlapping mechanisms of action, we hypothesized that combination therapy reduces symptom burden in patients with cancer pain.

We conducted retrospective chart reviews of supportive care clinic patients at a National Cancer Institute-designated center with cancer pain prescribed duloxetine and methadone. Outcome measures included Edmonton Symptom Assessment System (ESAS) total scores and subscores from clinic notes before and after starting combination therapy.

A total of N=41 patients met study criteria with complete ESAS (and N=2 with incomplete) scores. Combination therapy significantly decreased total ESAS (5.6, P=0.046), anxiety (1.1, P=0.018) , and emotional (1.8, P=0 .023) scores versus monotherapy. Pain scores (0.9, P=0.052) were also decreased. All patients reported cancer-related NP symptoms.

The combination of methadone and duloxetine relieves symptom burden with significant reductions in total ESAS, anxiety and emotional scores. Pain scores were also decreased, suggesting treatment benefit. This work was accepted for the 2020 Annual Meeting and published in Annals of Palliative Medicine (doi:10.21037/apm-20-1455). The publisher provided permission to present this work.

Methoxyflurane, marketed under the brand PenthroxTM, serves as a short-term, safe, and fast-acting analgesic at sub-anaesthetic doses. When self-administered from a handheld inhaler, this analgesic may benefit cancer patients in short and painful procedures. The purpose of this review is to compile the existing evidence on methoxyflurane use for painful cancer-related procedures. Eligible studies assessed the efficacy of methoxyflurane to reduce pain in cancer-related procedures.

The literature search yielded two randomized controlled trials and three nonrandomized studies ( Figure 1 ). Table 1 presents study characteristics and results. Procedures included prostate biopsy, colonoscopy, and bone marrow biopsy. The studies showed varying results. Spruyt et al. (2014) showed a lower overall pain score of methoxyflurane over control, but Nguyen et. al (2015) showed worse pain control of methoxyflurane over control.

Current literature on the topic of methoxyflurane-induced pain relief for cancer-related procedures is sparse. Methoxyflurane may be beneficial in appropriately selected individuals to assist with procedural pain management, with less respiratory sedation and quicker procedural recovery times as compared to traditional sedation methods. Procedural pain management may not be as effective in certain patient sub-groups motivating the need for additional larger series comparative studies.

Pain is often experienced by cancer patients, impacting their quality of life and adherence to treatment. Despite increasing advancements in cancer pain management, access to pain control therapies depends on good communication between patients and health care teams. Methods Instituto Oncoguia, a Brazilian national cancer patient advocacy NGO, conducted a cross-sectional study to investigate the impact of pain in the life of cancer patients. An online survey was distributed to Oncoguia's mailing list and shared on social media. A section of the questionnaire focused on the communication of cancer pain between patients and their health care teams.

A total of 543 cancer patients participated in the survey, and 71% stated to have pain during treatment. Of the 185 patients who described their pain experience, 92% had discussed it with their oncologist and 72% had reported it to other members of the health care team (e.g., nurses, psychologists, and social workers). Among 128 patients who talked about their pain to the health care team, 78% were informed that it was a normal part of their treatment. The belief that pain was a normal part of treatment was also the main reason why patients had not discussed pain with their oncologists.

Our study indicates prevalence of misconceptions about cancer pain among patients and healthcare professionals; a barrier that needs to be addressed for greater access to pain management and control in Brazil.

Most cancer patients experience many pain episodes depending on disruptive elements, leading them to the emergency room. The objective of the article is to describe common pitfalls that need to be avoided, as well as opportunities to be seized for repositioning patients back on their care pathway.

Critical reflection based on literature analysis and clinical practice.

Most forms of cancer are now chronic, evolving diseases, and patients are treated with high-technology targeted therapies with iatrogenic effects. Moreover, the multimorphic nature of cancer-related pain requires dynamic, interdisciplinary assessments addressing its etiology, its pathophysiology, its dimensions (sensory-discriminatory, cognitive, emotional and behavioral), and the patient's perception of it, in order to propose the most adapted therapies. However, for most patients, cancer pain remains underestimated, poorlyassessed and under-treated. In this context, the key steps in emergency cancer pain management that will be described in this poster are: -Quick relief of uncontrolled cancer pain -Assessment and re-assessment of the pain and the patient -Identification of disruptive elements leading to uncontrolled pain Conclusions Pain emergencies should be part of the cancer care pathway, and, through supportive care, provide an opportunity to help cancer patients both maintain their physical, psychological, social balance, and anticipate further painful episodes.

Many authors highlighted different models for early integration of supportive care, from as early as the cancer diagnosis. These integrative models have demonstrated their positive impact on patient quality of life, symptoms management, health costs, and optimization of care pathways, regardless of the management method (outpatient, in hospital, home care). Cancer pain medicine fits perfectly into this early supportive care dynamic and has also undergone its own series of determining changes.

Critical reflection based on literature analysis and clinical practice.

This new model offers a dynamic and exhaustive vision of cancer pain as a singular clinical entity, taking into account its multimorphic characteristics (cancer pain experience can and will change during cancer: aetiology, physiopathology, clinical presentation and consequences of pain) and the disruptive elements that can occur to influence its evolution (cancer evolution, concomitant treatments, pain from associated diseases, comorbidities and complications, or environment changes). Our model establishes the main key stages for interdisciplinary management of cancer pain.

Given the difficulties still present in the management of pain in cancer, and the chronic condition of cancer, the concept of multimorphic pain proposes a practical, optimized and innovative approach for clinicians and, ultimately, for patients experiencing pain.

Opioid-induced constipation (OIC) is the most common side effect of opioids, that can be responsible for deterioration of the patients' quality of life (QoL) and an inappropriate reduction in opioid doses. This realworld study mainly aimed assessing the efficacy and safety of naloxegol for the treatment of OIC in cancer pain patients with inadequate response to laxative(s), and the evolution of their quality of life. Methods A non-interventional, 4-week follow-up, French study was conducted between 2018 and 2019. Eligible patients were aged ≥18 years, received opioids for cancer-pain, and started naloxegol for OIC with inadequate response to laxatives. The response rate to naloxegol was assessed at W4. The evolution of QoL was measured using the Patient Assessment of Constipation Quality of Life (PAC-QOL).

Results 124 patients were included (mean age 62±12 years; ECOG ≤2: 79%; primary cancer: lung 18%, breast 16%, prostate 11%, head and neck 9%, digestive 9%...; metastatic stage: 80%). At inclusion, the median opioid dosage was 60 mg of oral-morphine or equivalent. At W4, the response rate was 73.4% (95%CI 63.7%-83.2%) and 62.9% (95%CI 51.5%-74.2%) of patients had a clinically relevant change in QoL (decrease in PAC-QOL score ≥0.5 point). Related adverse events were reported in 8% of patients (7% with gastrointestinal events; one serious diarrhea).

Although cancer pain management is an integral component in the practice of oncology, many patients still complain of insufficient pain control. There is a need to pursue and strengthen strategies on how to adequately and effectively manage cancer pain. Methods This was a cross-sectional study which utilized a validated questionnaire designed to assess a physician's knowledge on pain management and opioid therapy, perceptions of the adequacy of cancer pain management, and significance of various potential barriers in optimal cancer pain management.

Out of the 280 PSMO members, 85 responded to the survey. Using numeric rating scales of 0 to 10, medical oncologists appeared to agree on their knowledge about opioid therapy as well as in their perceptions of pain management. Respondents have rated themselves highly (Med: 8; IQR [6] [7] [8] in their ability to manage cancer pain. There were similar responses to ascribing all potential barriers as significant in rendering optimal cancer pain management, with cost as the most considerable factor (Med: 8, IQR: 7-10). However, given two challenging clinical scenarios, 66% and 90%, respectively endorsed treatment decisions that were unacceptable to pain experts.

Filipino medical oncologists have shown agreement on their knowledge but perceived significant barriers in cancer pain management, with cost as the most considerable factor. Educational strategies, positive attitudinal change, and multidisciplinary collaboration with pain or palliative care specialists should be strengthened to improve patient care.

As a consequence of the curative treatment after head and neck cancer diagnosis, this population may suffer a decrease on cervical and shoulder range of motion (ROM). Myofascial induction (MI) is a manual therapy approach focused on the functional restoration of the altered fascial system. The aim of this study was to demonstrate the efficacy of MI compared to the general care over the cervical and shoulder ROM in survivors of head and neck cancer (sHNC). Methods A pilot randomized controlled single blind study was performed. 32 sHNC participated on the study. A goniometer was used to evaluate cervical ROM (flexion, extension, rotations and inclinations) and shoulder ROM (flexion, abduction, external and internal rotation). Treatment (n=16) consisted in MI techniques (3 times/week during 6 weeks) and was compared with a waitlist (n=16) receiving general care after treatment. Comparisons between groups were determined using the IBM SPSS Statistics v.24.

Repeated measures ANOVA showed cervical ROM improved significantly in the treatment group compared to waitlist, in terms of flexion (p=.009), inclination and rotation to both sides (p<.05). Shoulder flexion (p=.018) and abduction (p<.001) on the affected side; flexion (p=.036) and external rotation (p=.021) on the unaffected side improved after MI treatment.

Myofascial induction treatment may increase cervical and shoulder ROM in sHNC when compared to the general care they receive after curative treatment. Larger studies and follow ups are needed to ensure the results.

Safe use of the opioid reversal agent naloxone in patients receiving chronic opioids is largely unreported. Various naloxone dosing strategies have been proposed to minimize withdrawal reactions in opioid-tolerant (OT) patients based on little clinical evidence. The objective of this study is to compare clinical outcomes after administering naloxone to opioid-naïve (ON) and OT oncology patients.

Inpatients who received intravenous naloxone for emergency opioid reversal between 2014-2018 were included in this retrospective crosssectional chart review. Patients were classified as ON or OT based on opioid usage 7 days prior to receipt of naloxone. Naloxone indication, dose, response and adverse effects were collected.

Ninety-six naloxone episodes (57 ON, 39 OT) were included. Mean age was 55 years. Major indications were unresponsiveness (30%) and oversedation (31%). Naloxone mean doses and response rates were similar in ON and OT patients and the majority of patients were initiated at ≤ 0.04 mg (70% vs. 64%, p=0.66). In OT patients, withdrawal reactions were observed after 23% of naloxone administrations, despite use of initial doses ≤ 0.04 mg in 78% of those administrations.

Response rates to naloxone were similar in ON and OT patients but withdrawal reactions occurred frequently in OT patients, despite utilizing a low initial dose with titration. Further studies are needed to evaluate the optimal strategy to reverse OT inpatients.

A. Reddy 1 

Opioid rotation (OR), substituting one opioid with another, and opioid conversion, changing the administration route, are frequently required to manage cancer pain. However, there may be significant variation in the OR ratios (ORR) and conversion ratios (CR) used. We aimed to determine the ORR and CR used worldwide among different palliative care (PC) professionals. Methods A survey consisting of various OR and CR scenarios and ratios was sent via email to the MASCC PC study group members, and via Twitter and Facebook posts directed towards PC physicians, advanced practice providers (APP), and pharmacists between September 4 and November 11, 2020.

We received 370 responses from 53 countries. 169 (46%) were from email, 166 (45%) from Twitter, 35 (9%) from Facebook; 276 (76%) were physicians, 46 (13%) APPs, and 39 (11%) were pharmacists. 158 (43%) were from North America. Table 1 shows the ORRs and CRs obtained from the survey. Although the median CR from intravenous to oral morphine varied significantly across regions (Europe 2.5, Canada 2, US 3), the variations with hydromorphone and fentanyl were more remarkable. There were multiple statistically and clinically significant differences in reported ORRs and CRs according to the region of the world, profession, and source of communication (P<0.05). (Tables 2 & 3) .

This survey provides unique insights into typical ORRs and CRs used in clinical practice internationally. It highlights the wide variation in ORR and CR among PC clinicians and the need for further research to standardize practice.

Cancer pain management (CPM) requires optimal use of breakthrough opioids (BTO). Aim: determine the prescription pattern of BTO and its ratio with scheduled (Sch) opioids used by primary care (PCP) and supportive care team (SC) consulted early and late for CPM.

Patients hospitalized at MD Anderson Cancer Center and 

LateSC, Early SC and PreSC groups received hydromorphone as the most common BTO, and MEDD of BTO ratio was contrary to recommended guidance of optimal BTO ratio.

Naloxegol is a PEGylated derivative of the μ-opioid receptor antagonist naloxone indicated for the treatment of opioid-induced constipation (OIC) in adult patients (pt) who have had an inadequate response to laxatives. Methods This is a single-arm, open label, multinational, prospective, real-world evidence (RWE) treatment study to evaluate safety and efficacy of naloxegol in routine clinical practice in adult pt with cancer pain diagnosed with OIC. Response rate is defined as three or more bowel movements per week, without the use of rescue laxative treatment in the previous 24 hours.

One hundred and seventy pt from 26 European sites were included and 143 had post baseline efficacy assessment. Median age was 66 years and 55% were women. Clinical characteristics are shown in table 1. Naloxegol initial dose was 25 mg in 82% of pt.

Of the 76 pt who completed 28 days of the diary, 72% (IC95%: 62.3 -82.4) achieved response. BFI score was < 30 points after 4 weeks of treatment in 37% of pt and change in BFI score was ≥12 points in 64% of pt. There were statistically significant differences between baseline and final visit in BFI overall score. Twelve pt had adverse reactions leading to study discontinuation (table 2) .

Results show the efficacy of naloxegol in this RWE treatment study. Naloxegol seems to be generally well tolerated. The most common related adverse events were gastrointestinal, as expected. RWE seems to be a useful methodology to assess the real life use of naloxegol and its efficacy in cancer pt.

E. Savaş 1 1 Counselling center of Dr. Esra Savaş, İstanbul, Turkey

There is increasing awareness that cancer disease affects people in several aspects, physical, social, financial, psychological, and spiritual. In addition to the medical process of cancer, people with cancer might have psychological disorders too. Adjustment, depression, or anxiety disorder could become a comorbid diagnosis of cancer disease. Therefore, psychotherapy could be a necessity rather than a luxury for people with cancer. Literature showed that cognitive behavior therapy is one of the effective psychotherapy approaches during the cancer process. This paper reviews the definition of oncology and psycho-oncology with current statistics of cancer morbidity and mortality. To provide effective therapeutic support, this paper includes cognitive behavior therapy's techniques and a case formulation of a vicarious case who applied therapy during the prostate cancer process. Vicarious case presentation illustrates the clinically important information and implication process of the treatment plan. Further, to inform the readers about the way of implying effective techniques, this vicarious case shows the effective use of cognitive-behavioral therapy principles. 

The main objective of this study was to analyze the quality of life (QOL) and safety of naloxegol, for the treatment of opioid-induced constipation (OIC) in patients with cancer, in a real-world 12-month follow-up study.

This prospective study was conducted in 16 Spanish centers. Patients older than 18 years, with active oncological disease who were under treatment with opioids and Karnofsky ≥ 50 were selected. OIC with inadequate response to treatment with laxative (s) was the main diagnostic. All the patients were treated with naloxegol according to clinical criteria. QOL related with OIC and global QOL were measured with the PAC-QOL, and the EuroQoL-5D-5L questionnaire respectively. Results A total of 126 patients were included, being 58.7% male. With a mean age of 61.5 years (34-89), about 67.5% had metastases. PAC-QOL total score and all its dimensions improved from baseline to 12 months (p<0.0001, Figures 1, 2) . The improvement was clinically relevant in 50.8% of the patients at two weeks and reached 58.7% at 12 months. Global QOL was preserved during the study. A total of 28 adverse reactions (AR) mainly gastrointestinal were observed in 15.1% of the patients (19/126), 75%(21) mild, 17.9%(5) moderate and 7.1% (2) severe. Most AR (67.9%) appeared in the first 15 days of treatment with naloxegol, all were solved, and in 4.8%(6/126) caused treatment withdrawal.

The results of this first real-world-data study showed the long-term good tolerance of naloxegol in patients with cancer and the improvement in OIC related QOL."

Interventional therapies for patients with cancer pain are often underutilized, but some patients who are not relieved by pharmacological therapies require interventional therapies. The purpose of this study was to clarify the availability of interventional therapies and factors related to interventional therapies for refractory cancer pain. Methods A cross-sectional survey using a self-administered questionnaire about interventional therapies including celiac plexus neurolysis, phenol saddle blocks, epidural infusions of local anesthetic combined with opioids, and intrathecal therapy was conducted among pain specialists (PSs) in Japan in 2020.

A total of 545 (49%) responses were analyzed from 1112 questionnaires sent. Of the four procedures, 40.9-75.2% of the PSs responded that it is possible to implement each procedure by themselves. On the other hand, 47.5-79.8% did not implement each procedure, and only 2.5-12.9% implemented each procedure in more than 9 cases in 3 years. Based on the results of multivariate analysis, the number of treated patients with cancer pain and difficulties in gaining experience were significantly related to therapy implementation.

Although more than half of the PSs responded that it is possible to implement each procedure, the actual number of implementations is small and may not be sufficient. It seems necessary to train PSs and facilitate access to PSs to lead to the implementation of therapeutic procedures. Figure 1 . Evolution of PAC-QOL questionnaire total score from baseline to 12-months. Figure 1 . Evolution of PAC-QOL questionnaire total score from baseline to 12-months.

Pain is a common,distressing symptom in women with gynecologic cancer (GC).It is unclear whether mood and personality are associated with pain during treatment.This study aimed to explore1) overall and dynamic associations between mood (anxiety,depression) and pain and2) the moderating role of personality (neuroticism, conscientiousness). Methods Secondary analysis of data from a longitudinal study of symptoms during chemotherapy for GC.Participants (n=27) rated daily symptom severity(0-10) at worst in the past 24 hours;neuroticism and conscientiousness were assessed at baseline (NEO FFI).Four cycles of daily pain,anxiety,and depression ratings were analyzed.We used multilevel modeling to evaluate relationships among anxiety, depression,and daily pain,and interaction effects of mood and personality on pain.A time-varying effect model (TVEM) was used to evaluate dynamic associations between pain and mood.

Multilevel modeling showed significant associations between pain and anxiety(b=0.24,p<0.01) and depression (b=0.30,p<0.01).Neuroticism moderated associations between anxiety and pain(b=0.15,p<0.05);anxiety was more strongly associated with pain in those with higher neuroticism.TVEM showed a decreasing trajectory of pain and decreasing effects of anxiety(coefficient range:0.66-0.23) and depression(coefficient range:1.21-0.43).

Multilevel modeling and a TVEM supported associations between mood and pain over time.Neuroticism may exacerbate the influence of anxiety on pain.These results can inform interventions to reduce pain among women with GC.

Electronic medical records for consecutive oncology outpatient visits were analyzed retrospectively. Systolic and diastolic BP (mmHg), and HR (beats/min) were identified at diagnosis (T1) and final visit (T2; >7 days after T1 

The study group had significantly higher triglycerides (TG), and atherogenic indices than the control group (p< 0.001), while HDL-Cholesterol (HDL-C) was significantly lower in the study group (p< 0.001). TG was significantly positively correlated with systolic and diastolic blood pressure; HDL-C had a significant negative correlation with BMI, systolic and diastolic blood pressure. The lipid ratios (TC/HDL-C, LDL-C/ HDL-C ) were significantly positively correlated with body mass index (BMI), systolic and diastolic blood pressure. The Framingham Risk Score showed that only 2 subjects in the study group (4.4%) were at a high risk of having a cardiovascular event.

Breast cancer patients have a higher prevalence of dyslipidaemia and cardiovascular risk than the normal population.

There is little data on mortality patterns for individuals who survive for an extended time after cancer. We investigated causes of death for those who survived more than 5 years post cancer diagnosis and compared the mortality rates to the expected rates in a general population. 

Three hundred sixty patients with SC were screened, and 348 patients were included. The majority were males (69%) and British nationality (14%), followed by Qatari (11%). About half of the cases (51%) were BCC, 20% were SCC, and 14% were MM. Fourteen percent had a history of cancer themselves. The incidence of exposure to diuretics and SC was 17.5% (CI:0.14-0.22) p-value 0.001 and HCTZ was 8.6% (CI:0.6-0.12) p-value 0.001. There was no statistical significant association of diuretics use and BCC, SCC, MM. However, there was an inverse association between SCC development and the use of other non-HCTZ diuretics OR 0.4 (CI:0.14-1.14) p-value 0.01. Conclusion: There is no significant association between diuretics use and BCC, SCC, or MM risk in Qatar.

A CASE REPORT.

Chemotherapy including anthracycline for patients with heart failure is one of the most difficult challenges for oncologists.

We performed chemotherapy including anthracycline for a breast cancer patient with left ventricular (LV) dysfunction after peripartum cardiomyopathy.

A 43-year-old female with a history of peripartum cardiomyopathy was diagnosed with stageIIIA left triple negative breast cancer. Although neoadjuvant chemotherapy including anthracycline and taxane was standard in this setting, we used only taxane as preoperative chemotherapy to avoid cardiotoxicity of anthracycline because of her chronic heart failure with left ventricular ejection fraction(LVEF) of 45%. She underwent total left mastectomy and left axillary lymph node dissection. We added anthracycline as postoperative chemotherapy considering the histological therapeutic effect. Our team including onco-cardiologist managed her heart failure using mineralocorticoid receptor antagonist and angiotensin receptor-neprilysin inhibitor, closely assessing electrocardiogram, chest X-ray, echocardiography, and blood data during and after chemotherapy. We performed blood transfusion to maintain the hemoglobin level of 9-10 g/dL. LVEF remained within 40%-50% and the maximum level of brain natriuretic peptide was 97.2 pg/mL.

We could complete anthracycline regimen for a patient with LV dysfunction after peripartum cardiomyopathy without compromising anti-cancer intensity although we need to check the late toxicity. Onco-cardiology team enabled management of such a difficult case.

Cardio-oncology is a progressive field. Research in this area suggests that cancer itself can damage the heart, independent of cancer treatmentrelated cardiac dysfunction (CTRCD).

Establish the nature of cardiovascular (CV) abnormalities reported in cancer, excluding CTRCD.

Scoping review search included CV abnormalities in adults with solid tumour malignancies, and excluded CTRCD and thrombotic events. Three databases (CINAHL, Embase, Medline) were searched, supplemented by a handsearch. All screening and data extraction was done by two researchers with consensus reached for any conflicts. Given the heterogenous nature of the studies identified, data synthesis was narrative.

The search identified 28412 studies. Following de-duplication and title/ abstract screening, 123 studies were assessed for full-text eligibility. Thirty-six studies are included in the final analysis. Types of abnormality identified include cardiomyopathy (13, including Takotsubo (8)), autonomic nervous system (ANS) dysfunction (9), raised biomarker (7), reduced myocardial strain (4) and others (3). Due to variable study design, prevalence was not determined. CV abnormalities were associated with morbidity and shortened prognosis. Background Higher levels of inflammation (like C-reactive protein, CRP) is a known associate of depression and anxiety, and is involved in the pathogenesis of CVDs. Furthermore, both cancer and cancer treatment including chemotherapy and radiation can lead to elevated levels of inflammation. We will therefore examine whether the relation between depression and anxiety with inflammatory markers among patients with either CVD or cancer is different from those with both conditions.

In the TweeSteden Mild Stenosis (TWIST) , 6% of the included patients with non-obstructive coronary artery disease (NOCAD, luminal narrowing <60%), a type of ischemic heart disease had a history of cancer. The TWIST patient sample was therefore used to explore whether the association between depression and elevated inflammation (hsCRP) was similar for NOCAD-patients with and without a history of cancer.

The association between depressive symptoms and increased hsCRP levels is stronger among NOCAD-patients with a history of cancer than among NOCAD-patients without a history of cancer. Furthermore, whereas this relation is mediated by lifestyle factors among NOCAD-patients without cancer, the association remained significant after adjusting for BMI, smoking, and physical activity among NOCAD-patients with a history of cancer.

The stronger association between depression and hsCRP among NOCAD-patients with a history of cancer indicates that there may be an additive or synergistic effect of having NOCAD and cancer for general inflammation and possibly depression.

Sarcopenia -loss of skeletal muscle and function -is prevalent in cancer and associated with morbidity and mortality. Loss of cardiac muscle may HNAs offered by text raised a higher number of concerns and information needs compared to those not offered by text. 31% of HNAs not offered by text raised nil concerns compared to 15% in HNAs offered by text. 'Worry, fear or anxiety' is the top concern raised across both modes of HNA delivery. 56% of patients completing a text HNA raised this as a concern, with a score of 6.5, compared to 26% of patients completing a HNA by other means, with a score of 5. 

There were 217 first COVID-19 hospitalization encounters during the study period with 80% occurring during the months of June through August 2020. Of those hospitalized, the mean age was 59 years, 54.3% were female and 52% of patients were white. Patients were hospitalized for a mean of 11.2 days. 24% of patients received ICU level of care. 25% of patients were classified as having severe disease based on oxygen requirement. The most common COVID-19 directed treatment given was dexamethasone, given to 33.6% of patients, followed by remdesivir (32.3%). Inpatient mortality was 10.6%. Among those discharged alive, the all-cause readmission rate was 32%.

The impact of COVID-19 on cancer care and cancer outcomes is significant. It is important to describe the different patterns of the disease among patients with cancer in order to adapt care to this vulnerable population.

The outbreak of COVID-19 pandemic dramatically affected health systems worldwide. Aim of this study was to assess the variation of oncology workload in 2020 in the Oncology Department of Udine, Italy.

Activity volumes in 2020 were extracted from the electronic "Data Warehouse" accountability system and compared with historical activity in 2019, with a focus on the peak of COVID-19 pandemic (February-May 2020). The activities analyzed included: new patients referrals, first consultations, new therapy assignments, treatment prescriptions and therapy administrations, disease re-assessments, follow-up visits, teleexaminations and unplanned presentations. Results A significant reduction in unplanned presentations (-23%) and a negligible reduction in first consultations (-5%) and new patients referrals (-10%) was observed. New therapy assignments, treatment prescriptions and therapy administrations confirmed the increasing trend of the previous year (+1%, +2%, +3%, respectively). A substantial reduction in follow-up visits (-28%) was observed throughout 2020 due to their replacement with telephonic interviews. Similar trends were observed in the four-months peak period, with a higher decrease in follow-up visits in 2020 vs 2019 (-51%), whereas treatment-related activities remained stable.

In our Oncology Department, strict triage procedures, serial swabs for patients and healthcare professionals and strategic follow-up visits remodulation were crucial to maintain stable performances on critical activities throughout the COVID-19 pandemic. The COVID-19 pandemic prompted worldwide stay-at-home orders and broad suspensions of elective medical and dental care to prevent risk of viral transmission. However, patients with cancer continued to require in-person care and active treatment for their disease. We herein report the clinical experiences of three oral oncology services at major cancer centers in Canada, the United States, and Brazil during the early period of the pandemic. Each center conducted a retrospective chart review of all patients seen by the oral oncology service from 6 weeks prior to, and 6 weeks after national declaration of stay-at-home orders. Patient visits were categorized as outpatient or inpatient, and as in-person or virtual. Each center adopted measures to minimize risk of COVID-19 transmission including screening for symptoms and isolating and testing screenpositive individuals and use of personal protective equipment. There was a reduction in visits during the study period, with a total of 3,154 visits during the 6 weeks prior to, and 1,531 in the following 6 weeks after stayat-home orders (reduction of 51.5%). Virtual visits increased from 1.4% to 17.3% of total visits, facilitating the provision of care for both established and new patients, allowing for effective triage of potentially urgent problems. Various strategies, often coordinated at the institutional level, were implemented to maintain essential oral oncology care during the COVID-19 pandemic. We anticipate many lessons learned from this experience that will improve access to oral oncology post-pandemic.

The COVID-19 pandemic has added a layer of complexity to individuals with cancer at high risk for symptom burden. Further, measuring symptoms for any disease, in the midst of COVID-19 without recognition that it is occurring would be a major source of historical bias. Thus, the purpose of this study was to improve our understanding of the critical social and behavioral changes brought upon by the COVID-19 pandemic and measure this impact among women being treated for breast cancer.

Using the well-validated PROMIS® 29, self-reported symptoms from 144 women with breast cancer who were current study participants in a longitudinal study were compared before and during the COVID-19 pandemic.

Frequent changes occurring after April 2020 were noted in the self-report of symptoms, especially in anxiety, fatigue, sleep disturbance, and social interaction. There was an increase in study participants who endorsed feeling fearful, or helpless. Study participants when asked to rate their sleep quality, reported an increase in an inability to fall asleep and a decrease in the endorsement "my sleep was not refreshing". Persistent themes in the qualitative comments were feeling "overwhelmed by the virus," or feeling "lonely"; especially in those women who lived alone or in more rural communities Conclusions These self-reported outcomes demonstrate how COVID-19 has affected self-reported symptoms, underscoring the importance of adding the impact of to the analysis of a longitudinal study. Nutrition during cancer treatment contributes to treatment tolerance and disease-related outcomes (Caillet 2017). Compromised nutrition is common in cancer patients. We hypothesized that the COVID-19 pandemic would worsen food insecurity (FI) in this population. An Internet-based survey was publicly available over 2 months (4-6/ 2020) on OncoLink.org. Adults diagnosed with cancer responded to queries about demographics, treatment variables, practical needs, and financial stressors. Questions surrounding FI included the ability to pay for food, fear of viral exposure from obtaining food, and ability to access food delivery. 249 cancer patients completed the survey; 89% Caucasian, 93% US residents, median age 60 (range 28-84). The most common diagnoses were hematologic (37%) and breast (23%) cancers. Half (51%) reported FI, most frequently due to fear of being exposed to COVID 19 (45%). Other barriers included delays in food delivery, difficulty finding needed items, and costs. One respondent was unable to access food because online platforms did not accept food stamps. Reduced access to food correlated with feeling more socially isolated (p=.0014) and compromised mental health (p<.00001). The COVID-19 pandemic has impacted the ability of cancer patients to safely access food, potentially exacerbating the risk for malnutrition and impacting cancer treatment outcomes. While some aspects may have improved since the early pandemic, FI related to income and fear of exposure likely persists. Oncology treatment centers should be mindful of the risk of FI among cancer patients.

Little is known about patient satisfaction with cancer rehabilitation delivered via telemedicine.

Patients seen via telemedicine by the Cancer Rehabilitation Program at the McGill University Health Centre were administered a telemedicine satisfaction questionnaire after their first and third visits. The questionnaire comprised 15 statements rated on a 5point Likert scale, and addressed overall satisfaction and quality of care.

Fifty-two patients completed the questionnaire between March 25 and September 23, 2020. At the first visit, overall satisfaction with telemedicine was rated high (strongly agree or agree) by all 52 patients (100%). Twenty-nine patients (55.8%) primarily represented by males, younger adults (≤69 years old ), patients in remission (rather than patients on treatment or cachectic) showed a stronger (>20%) preference for face-to-face rehabilitation. Findings from the third telemedicine questionnaire were similar to the first visit.

In the COVID-19 era, despite high satisfaction levels with telemedicine, a slight majority of cancer patients still prefer face-to-face to telemedicine rehabilitation. However, more vulnerable oncology patients, such as females, elderly, on cancer treatments and cachectic, are more likely to prefer telemedicine rehabilitation.

The clinical characteristics of COVID-19 are now well-described as is symptom management in acute hospital and in-patient hospices.There is however a paucity of published data on patients managed by community palliative care teams.

This review aims to describe the clinical characteristics, symptom management and outcomes of patients with COVID-19 managed by two large community palliative care teams. A retrospective review of patients managed by two community palliative care teams was conducted during from 1 March 2020 until 9 July 2020 assigned an ICD-10 diagnosis of COVID-19.In this period 17 patients were identified with a diagnosis of COVID-19 infection at any point whilst under the care of these two large community palliative care teams in Dublin, Ireland which serves a population of 697,644 people.

Twelve patients died, four patients were discharged, and one patient remains a patient. All patients had at least one co-morbidity, 11 had ≥4 co-morbidities. Four were referred for symptom control in the context of malignancy and subsequently contracted the virus. COVID-19 co-infection contributed to death in two patients. Eleven of the seventeen patients were nursing residents. Seven of the deaths occurred in a nursing home. Eleven patients had evidence of advance care planning. Fatigue, pain and breathing problems were identified has the most common symptoms.

Community palliative care teams anticipated a windfall of referrals at the beginning of the pandemic. This was however not the experience of these two palliative care teams.

In an attempt to minimize the transmission of the Coronavirus (COVID-19), healthcare institutions implemented strict visitor restrictions, dramatically changing the traditional caregiver presence during clinical encounters.

We reviewed visitor policies of the 50 adult National Cancer Institute Comprehensive Cancer Centers' (CCC) public-facing websites as of June 17th, 2020. We cataloged the visitation policies for inpatient, outpatient, and end of life (EOL) for visitors as well as psychosocial resources for patients and caregivers.

All 50 CCCs implemented visitor policies by mid-June 2020 with most (n=43, 86%) in place by mid-April 2020. Of the 37 CCCs (74%) that offered one or more COVID-19-specific psychosocial resources, only 12 centers (24%) provided live support (telephone [n=4] or in-person[n=8]). All CCC's had inpatient and outpatient policies in place, but only 40 (80%) published EOL-specific policies (table 1) . There was marked variability in policies (including number of visitors, time allowed, etc.) with no two centers having identical policies. Some institutions allowed other exceptions to the visitor policy, including cognitive/physical disabilities (n=19, 38%) and discharge planning/caregiver education (n=14, 28%).

Caregiver involvement has far-reaching implications in oncologic care. The restrictive visitation policies and variability across CCCs bring added distress and uncertainty. Establishing uniform practices across CCCs promotes standardization of high-quality care for patients during these unprecedented times.

The COVID-19 pandemic led to reallocations in medical care in order to preserve intensive care resources. Concerned about the possible effects, the German Cancer Research Center, the German Cancer Aid and the German Cancer Society set up a joint task force to monitor potential deficits in the care of oncological patients.

Since March 2020, the managing directors of 18 Comprehensive Cancer Centers (CCCs) were continuously surveyed using a standardized questionnaire about changes in oncological care.

Across all survey rounds, there were considerable restrictions in the area of follow-up, psycho-oncological and non-medical care. These restrictions in the predominantly "verbal patient care" were reported almost constantly over the entire duration of the first wave of COVID-19 by virtually all CCCs. Structural and capacity restrictions were also found in other areas, such as imaging diagnostics, systemic therapy of solid and hematological neoplasms, tumor surgeries, and palliative care. After an improvement of the situation during summer 2020, further restrictions were reported for the second wave of COVID-19 at the end of 2020. In 2021, care capacities improved again, but did not reach pre-COVIDlevels yet.

Both waves of the COVID-19 pandemic have led to significant restrictions in psycho-oncology, follow-up and non-medical supportive care. Restrictions were also reported for diagnostic work-up and therapy, but to a lower extent. Whether these restrictions will negatively impact longterm survival will have to be awaited. 

To determine the COVID-19 pandemic influence on a cancer hospital dental clinic.

Visits were quantified for the 6 weeks prior to COVID19 and compared with the first six weeks into the pandemic. Results 2070 patient visits were used in this study. The reason for visits were categorized by procedure and compared across time. Significant (p<0.05) reductions in patient volumes were seen for recall exams, restorative work, prosthodontics, hygiene, oral pathology, tele/video conference calls. There was no significant difference in new patient pre-cancer therapy exams, endodontics, oral surgery, and emergencies.

The COVID-19 pandemic had a significant impact on provider ability to deliver dental care across a number of categories.

Novel COVID-19 pandemic has brought to the fore various challenges faced by pain and palliative care physicians working in oncology setup. Cancer care has been afflicted a lot during the pandemic, with challenges faced by patients and their caregivers as well as the healthcare workers. The questionnaire based online survey was conducted to explore the challenges faced, strategies adopted and to compare the challenges between different oncology setups.

After obtaining institutional ethical clearance the online questionnaire prepared was rolled out to pain and palliative care physicians working all over the country with the help of social media platforms. The results were expressed in absolute number, percentage and comparisons were made with the help of Fisher's exact test.

Maximum challenges faced were the fear of carrying infection back home (91%), the possibility of attending to a COVID positive case because of inadequate space and screening (62%) and limited services provided by NGO's during pandemic (71%). Strategies commonly adopted were the provision of necessary personal protective equipments (83%), the conduct of educational sessions for the task force members (67%), maximum utilisation of available space in the hospital (85%) and stockpiling of necessary medications and equipments (75%) Conclusions It is the need of the hour to formulate strong and effective strategies to overcome the challenges encountered by pain and palliative care physicians so that we are equipped in the future to deal with any kind of pandemics. We have selected 3 key performance indicators and compared them between 2019 and 2020 (Mar-Dec): number (nº) of medical appointments (appt); nº of patients and nº of preparations (prep) made by the pharmacy (IV and per os) in Cytotoxic Preparation Unit (CPU). These data were obtained using SONHO® software.

The following results were obtained:

ODH had to change significantly to meet the challenges presented by COVID-19. In pandemic early stages, non-COVID-19 care was slowed down to assist COVID patients (2) . Here, this happened particularly in April and May. However, cancer treatment was meant to continue and ODH has made substantial progress to resume its normal activity, as shown by the increase of medical appt and the nº of prep during summer (Jun-Sep), although short of 2019. From Sep, the nº of COVID patients began to rise again, similar to other European countries, which negatively impacted the ODH indicators. There is only a slight difference between 2019 and 2020. Considering the current paradigm, it can be perceived that there was a decrease in the nº of appt and patients, although not that meaningful. In fact, the nº of prep increased by the end of 2020.

The COVID-19 outbreak has severely spread across Italy, in particular in Lombardy. This study aims to understand how cancer patients reacted to the pandemic, and whether their quality of life (QoL) was impacted.

In June 2020 we enrolled 111 cancer patients treated in the Supportive Care Unit of National Cancer Institute (Milan) and 201 healthy people from the general population. Secondly, we assessed both quantitatively and qualitatively for fears, COVID-19-related beliefs and QoL.

The fear of COVID-19 was significantly lower among patients, (41% vs 57.6%, p=0.007) as well as fear of cancer (61.5% vs 85.6%, p<0.001) and other diseases. The perceived risk of getting COVID-19 was lower among patients (25.2% vs 52.7%, p < 0.001), as well as the belief of having been exposed to SARS-COV2 (18.1% vs 40.8% p<0.001).

Whereas the physical component of QoL was better among the population (54.5 vs 43.8; p <0.001), the reverse was true for the patient's psychological well-being (44.6 vs 39.6 p<0.001). The qualitative data show a reduced psychological impact of COVID-19 on the cancer patients, compared to the controls. This is due to various reasons, including the awareness of being treated for cancer in an oncology public health center (frequent clinical examinations) which was quickly reorganized to continue treating patients (COVID-19 protection measures promptly adopted).

Cancer diagnosis, together with a fast and proper hospital re-organization, may act as protective factors from fears and psychological conseguences of COVID-19 outbreak.

Though the COVID-19 pandemic has affected all individuals, it is critical to understand its effect on specific populations, such as immunocompromised individuals. Hematopoietic stem cell transplantation (HSCT) is a potentially curative treatment for hematologic malignancies, with 22,000 HSCTs performed annually in the U.S. Patients receive intensive chemotherapy prior to transplant and can potentially stay immunocompromised for longer periods of time, which would put them at increased risk for COVID-19 morbidity and mortality.

We carried out a quantitative survey (N=54) of patients either waiting for transplant or post-transplant to gain an understanding of their COVID-19 perceptions and intentions to adhere to recommended preventive behaviors. We used the Health Belief Model (HBM) as a theoretical framework.

We used multiple linear regression to test for predictors for COVID-19 preventive behaviors. Of the HBM variables, both perceived benefits of COVID-19 preventive behaviors (p=.012) and self-efficacy related to COVID-19 preventive behaviors (p<.001) were significant predictors of intent to carry out these behaviors. Perceived severity of and perceived susceptibility to COVID-19 were not significant; neither were perceived barriers to COVID-19 preventive behaviors.

These findings indicate possible strategies for communicating COVID-19 preventive behaviors to HSCT patients, which will not only be crucial as long as herd immunity is not reached but also for related as well as future infectious disease outbreaks. 

The implementation of institutional structured processes for GOC-PPC resulted in rapid sustainable adoption of ACP documentation for COVID-19 positive cancer patients. This was highly beneficial for this population during the pandemic as it demonstrated the role of deft processes in care delivery models, which will be beneficial in the future when rapid implementation is needed.

Provider-patient communication (PPC) about goals of care (GOC) facilitates goal-concordant care (GCC) delivery. Hospital resource limitations imposed during the pandemic made it vital to deliver GCC to a patient cohort with COVID-19 and cancer. Our aim was to understand the population and adoption of GOC-PPC along with structured documentation (ACP) in this population. Methods A multidisciplinary GOC task force developed processes for ease of conducting GOC-PPC and implemented structured documentation. We looked at PPC and ACP documentation pre and post implementation alongside demographics, length of stay (LOS), 30-day readmission rate and mortality.

Unique 577 patients were identified with a mean age of 59 yrs; 52% male, 63% White, 28% Hispanic, 16% Black & 3% Asian. Active cancer was identified in 94.5% patients of which 49% were solid tumors and hematologic malignancies 40%. LOS was 9 days, 30-day readmission rate of 17% and inpatient mortality of 11%. Inpatient ACP documentation was significantly higher post-implementation as compared to preimplementation (89% vs 60% P<0.05) We saw sustained ACP documentation throughout the pandemic suggesting effective processes.

The implementation of institutional structured processes for GOC-PPC resulted in rapid sustainable adoption of ACP documentation for COVID-19 positive cancer patients. This was highly beneficial for this population during the pandemic as it demonstrated the role of deft processes in care delivery models, which will be beneficial in the future when rapid implementation is needed. 

During the COVID-19 pandemic, cancer care needs to be tailored to the phases of the pandemic and health system priorities. Amendments to care should continue to provide quality, evidence-based care for people with cancer, while minimising their risk of exposure to, and harm from, COVID-19. Anticipating and managing increased anxiety in cancer patients and their carers is also vital.

Using published data and guidance and underpinned by the principles of the Optimal Care Pathways for people with cancer, Cancer Australia developed a conceptual framework for cancer management which maps care considerations across the cancer care pathway to various pandemic phases.

The framework supports evidence-based, risk-stratified approaches to guide decision-making about optimal care, with consideration of holistic needs of patients. It promotes infection control and resource prioritisation in the context of innovative care models and individualised treatment plans, underpinned by effective communication, psychosocial care, and shared decision-making.

In various pandemic scenarios, most aspects of cancer care are recommended to continue, with some modifications or pauses in care recommended only as the pandemic curve nears or exceeds health system capacity.

The framework is intended to inform best practice cancer care to support and improve outcomes for cancer patients during a pandemic. While the framework was developed for the Australian healthcare system and this current pandemic, the principles are transferrable to any jurisdiction and any pandemic.

Managing oral anticancer drugs side effects is a challenge for patients and primary care professionals. To encourage home support and improve cancer care coordination, we created a specific patient monitoring program with a previously valitated algorithm.

After collecting their informed consent, patients are asked to answer a survey periodically through their computer, tablet, smartphone. Specific surveys were created for each anticancer drug (or drug combination) regarding its possible, common or severe, adverse effects. Questions include CTCAE grade and impact on daily life. Our algorithm (previously validated in a test phase) classifies the patient in a four-level risk scale (green, yellow, orange and red).

Patients are immediately informed of their condition and receive medication management advices. Primary care or hospital team (depending on the risk level) are also notified with an alert through the platform.

Between Dec 2017 and Sep 2019, 392 patients were included. In a total of 819 alerts, 11% only were categorized as severe ones (7% orange and 4% red). For the severe toxicity cases with a declared evolution, 98% presented a favorable or stable outcome . Patients were highly satisfied (88%) with the program, 80% found it useful, 85% found the medical information appropriate and 86% wanted to continue to use Appli Chimio.

Appli Chimio is an innovative and well accepted way to support patients with anticancer drugs at home. Our unique algorithm is confirmed by the French Society of Oncology Pharmacy as a reference. The need for quality follow-up cancer care is on the rise, particularly for older adults. LifeChamps (https://lifechamps.eu/) is creating a digital support platform based on artificial intelligence and big data analytics to integrate patient-reported outcomes, sensor data and routine clinical data, to enhance follow-up cancer care. Our co-creation phase explored the views and expectations of potential end-users (patients, family/ caregivers and health professionals) of the developing system.

This mixed-methods design involved end-users from Greece, Spain, Sweden and the UK. Data collection was performed via either online surveys or telephone interviews. Framework analysis was applied to the dataset.

A total of 155 end-users participated, commenting on expected advantages, anticipated challenges, desired functionality and implementation aspects. Patients/family members generally felt it would be useful for personalised support and aid communication as there was frustration with the lack of follow-up services. Health professionals were supportive of the "proactive" functionality of the system. Anticipated challenges included issues with information management, impact on workload and infrastructure, and comfort in using technology.

The varied end-user insights into system requirements form a solid basis for action and further consultation in subsequent development cycles.

Smart health technology can support cancer symptom management. This study reports results from feasibility and acceptability testing of the Behavioral and Environmental Sensing and Intervention for Cancer (BESI-C) system to manage cancer pain in the home setting.

Participant dyads include outpatients with advanced cancer and their primary family caregivers. Data is collected by: 1) environmental sensors that measure noise, humidity, barometric pressure, light, temperature; 2) Blue Tooth beacons that localize dyad movement; and 3) smart watches worn by patients and caregivers with heartrate monitors, accelerometers, pedometers and a custom application for ecological momentary assessments (EMAs). Feasibility is assessed by logistic barriers with deployments, failures in data capture, and recruitment/attrition rates; acceptability is assessed by end-of-deployment surveys/interviews with dyads.

The first iteration of deployments (n=5) is complete. Feasibility challenges included: participant recruitment; rurality of dyads; battery life; EMA reliability; remote system monitoring; and deployment procedures.

For acceptability, dyads reported: BESI-C as low-burden; satisfaction with user interface of smart watch; improved communication with their partner; and interest in seeing and sharing their respective data.

Preliminary results suggest it is feasible to deploy BESI-C and dyads find the system acceptable. BESI-C offers an innovative approach to monitor and predict cancer pain and deliver personalized interventions. 

During the COVID19 pandemic, in line with UK government guidelines on social distancing, our department rapidly implemented the use of telehealth to facilitate the ongoing provision of cancer rehabilitation. We sought to evaluate and co-design telehealth services to meet the complex needs of our patients and carers at our tertiary cancer centre.

Experience based co-design (EBCD) methodology ( Figure 1 ) was adapted to include virtual methods. Patients and staff were recruited to take part in one to one virtual interviews. Patient interviews were video recorded, analysed and edited down to a 30 minute summary video. Patient and staff virtual events were undertaken thereafter. A joint virtual patient and staff event was undertaken, where staff could see the video and with patients as partners agree areas for change and develop groups for service co-esign.

Staff members (n=12) and patients (n=11) were interviewed. See Table 1 for participant demographics. Positive aspects regarding telehealth provision were highlighted including reduced financial and time burden on patients, and increased flexibility for both staff and patients. The key concerns included digital exclusion, safety, communication and patient choice with the development of 4 co-design groups to enact changes in these priority areas.

Using a participatory design approach, we have worked in partnership with patients and staff to ensure the safe, acceptable and effective delivery of rehabilitation services with integrated telehealth. 

In oncological setting, the use of electronic health records (EHR) in examination room remains a practical necessity. Based on existing literature, we have developed and tested an integration model, PRIME-EHR, that focuses on the best practice guidelines. To our knowledge, no randomized controlled trials (RCT) have been conducted to test the effectiveness of such models.

In this double-blind, crossover-RCT, 120 eligible cancer patients were enrolled between April 1, 2019 and February 15, 2020 at MD Anderson. Our objectives were to compare patients' perceptions of physicians' skills and their overall preference after they watched 2 standardized-scripted-video-vignettes of physicians: one portraying the use of a standard (S-EHR) and the other portraying use of a PRIME-EHR. Validated questionnaires to rate physicians' compassion (0=best, 50=worst), communication skills (14=poor, 70=excellent), and professionalism (4=poor, 20=very good) were used. Results PRIME-EHR, compared to the S-EHR, resulted in better scores for physician compassion (median [interquartile range], (5[0-10] vs. 12 ; P = 0.0009), communication skills (69 [63-70] vs. 61 [50-69]; P = 0.0026) and professionalism (20 [18-20] vs. 18 [14-20] ; P = 0.0058). The majority of patients preferred physician who utilized PRIME-EHR (70 [77%] vs. 21 [23%], P < 0.0001). Conclusions PRIME-EHR approach significantly improved patients' perception and preference for the physicians. This integrated model of healthcare delivery has the potential to improve communication and compassion in cancer care.

Mobile health applications (mHealth apps) have potential to provide personally tailored interventions. As the first step in translating a web-and phone-based intervention to an mHealth app, we conducted focus groups to identify 1) gaps in information and support in cancer care and 2) desired features for an mHealth app to support patients with gynecologic cancer and family caregivers (cancer dyads).

We recruited women with gynecological cancers (n=41) and their family caregivers (n=21) who received cancer care from a large healthcare system. We conducted eight focus groups using a semi-structured interview guide. We coded transcripts, then constructed a thematic matrix to identify common themes across focus groups.

We identified two themes related to current gaps in information and support: 1) The process of trying to find the right information/ resources is time consuming and often not relevant to their situation; 2) Dyads lacked confidence in deciding when or who to contact when worried about a new problem. Three themes emerged regarding desired features of the mHealth app: 1) centralized, trustworthy information; 2) timely recommendations tailored to specific personal and cancer related needs; 3) opportunity to interact with clinical and peer experts through the app.

There is a need to improve real-time management of concerns for cancer dyads. Recommendations voiced by dyads will guide adaptation of our mHealth app to improve management and also raises awareness about the uncertainties faced by dyads.

DIGIT-11 AN ONLINE TOOL TO HELP KEEP MYELOMA PATIENTS ON TRACK: MYETXSCHEDULER Introduction Complex treatment regimens are widely used in multiple myeloma (MM). We identified no system that enabled the scheduling of all aspects of treatment for MM patient. Aim To develop an online flexible tool for clinicians to create individual MM treatment schedules for patients to provide treatment schedule, improve adherence and enhance patient care. Methods MM nurses partnered with health technology myINTERACT to develop an online tool MyeTxScheduler. Content was developed based on Cancer Institute NSW Cancer Treatments Online (eviQ) and expert clinical experience. Standard MM protocols were included with ability to adapt as clinically indicated. Two expert advisory groups, patient group and health professionals reviewed tool content, structure and usefulness.

MyeTxScheduler was developed initially including 26 MM standard protocols. The clinician can amend each item, save, edit, add drugs, supportive care and pathology requests. The capacity to add additional drugs and amend was valued for additional flexibility for real world clinical application. Following positive feedback from expert advisory groups, and successful pilot, the MyeTxScheduler was distributed through HSANZ membership, and available to all clinicians as free download on tablet devices or online populating through the myINTERACT digital platform.

MyeTxScheduler enables clinicians to create individualized treatment schedules to provide to their patients at the point of care, enhancing quality patient care and nurse understanding of the complex MM treatment journey.

Mobile health applications (mHealth apps) provide a unique platform for delivering individually tailored supportive care interventions to people with cancer and their family caregiver (dyads). In preparing to adapt a web-based self-management intervention (SmartCare) to a mHealth app, we assessed dyads' interest in an mHealth app for supportive care and preferences for using the app individually vs. as a dyad.

We conducted 8 Zoom focus groups in June 2020 using a semistructured interview guide developed from the Consolidated Framework for Implementation Research. Group participants were women with gynecological cancers (WwC, n=41) and their family caregiver (n=22). Using rapid qualitative analysis, trained coders independently coded transcripts then constructed a thematic matrix to identify commonalities across groups. Results 48% of participants were interested in using the mHealth app to manage cancer-related supportive care needs; 14% denied interest and 38% did not express preference. We found strong support for two themes: 1) "Separate place to go." Both members of the dyad wanted a private place to "commiserate" with peers and to have autonomy when seeking information. 2) "Control over what is shared." WwC wanted control over personal health information the family caregiver can access and to be able to selectively share information through the app.

Overall, participants were open to using an mHealth app that supports both members of the dyad but wanted to have their own accounts to ensure privacy and control over what is shared.

The pandemic has resulted in reliance on virtual platforms for the provision of supportive care. Little is known regarding older cancer survivors' opinions and use of telehealth. This study utilized online semi-structured interviews to gather older cancer survivors' perspectives and use of telehealth in supportive care. Methods Potential participants were recruited through ResearchMatch to attain a representative sample. Content analysis were conducted by two independent coders for identification of common themes and count comparisons.

The majority of respondents (n=21; mean age=73.5±4.9) were female (57%), white (90%), and had a variety of cancer diagnoses. The vast majority of participants reported positive perceptions of supportive care including telehealth formats. Older cancer survivors endorsed virtual platforms for exercise, and basic check-ups but preferred in-person visits for major concerns and sensitive issues (e.g., mental health). Participants were regular users of consumer-based health devices especially Fitbits® and clinician-affiliated patient portals (e.g., EPIC MyChart®). Many felt that virtual supportive care was not needed for themselves personally, but the option could be helpful to others.

These findings suggest that older cancer survivors utilize online platforms for their general health; however, they prefer in-person visits for serious issues. These results can be used to inform clinicians and researchers about the appropriateness and provision of telehealth options for supportive care among older cancer survivors.

We explored using a meditation APP to treat negative mood in cancer patients.

We examined the feasibility (primary aim) and initial effects of a meditation APP over 2 weeks on cancer patients' self-reported symptoms. Participants from outpatient clinics were assessed using an expectancy scale, exit satisfaction survey, and pre-and post-trial HADS, PSQI, and ESAS-FS. Feasibility criteria were (1) > 50% enrollment and (2) ≥70% completing ≥ 2 meditations per week, as tracked within the APP.

The COVID-19 pandemic precipitated use of video consultation in palliative care. Questions remain about its ongoing role in care delivery. We assessed use of video consultation for initial assessments of new referrals to a Community Specialist Palliative Care Team (CPCT) to establish whether demographic characteristics are associated with success of video consultation.

All new referrals in November -December 2020 were tracked. Assessment modality at time of referral triage, planning and modality eventually used were recorded. Results 119 patients seen. 100 triaged to AA (Attend Anywhere video assessment). After contact with the patient, AA was arranged for 75. 50 assessments were conducted successfully; change in modality was required in 25. 3 required urgent domiciliary assessment. The remainder changed to telephone assessment because patients were unable to access the AA link (n=13), had difficulties with their smart device (n=2) or poor connection (n=7). Age, gender and disease (malignant v non-malignant) did not differ between successful and unsuccessful AA. A higher proportion of people who requested telephone assessment lived alone (7 of 22 v 5 of 75).

Of 100 new referrals to CPCT triaged to video consultation, 50 were completed successfully. Patient preference for telephone and technical difficulties were main barriers. Living alone may be associated with preference for telephone assessment. Demographics did not differ between groups, suggesting these should not be used to determine which assessment modality is offered. 

In light of the need to capture the effects of personalized medicine, the EORTC Quality of Life Group (QLG) released its Item Library in October 2017. Designed as a dynamic online platform containing all of the QLG's validated patient-reported outcome (PRO) measures, it allows users to create customized ad hoc item lists to complement static PROs, in cases where relevant symptoms might be missing. This work aimed at evaluating trends in its use between academic and industry users. Methods Data were extracted anonymously from Item Library user registration documents and a database was created to summarize information related to usage, capturing user type, item list creation, and research design.

From October 2017 to January 2021, 496 academic and 162 industry users registered for Item Library accounts. 98 item lists were created; 36 (37%) by academic and 62 (63%) by industry users. For academic users, 18 (62%) were designed for observational studies, 10 (34.5%) for clinical trials, and 1 (3.5%) for clinical monitoring. Industry users designed item lists for 75 different studies; 71 (95%) clinical trials and 4 (5%) observational studies. 38 (51%) industry studies used electronic PRO (ePRO) administration.

Item Library usage differs considerably between users, with the majority of item lists created by industry users for clinical trials and a stronger focus on observational research in academic use. This highlights the need for more tailored assessment, adapted to the treatments and outcomes under investigation, in industry-led clinical trials.

DIGIT-17 THE HARD SELL: COMPARING TRADITIONAL AND DIGITAL RECRUITMENT METHODS OF A PROSTATE CANCER RANDOMISED CONTROLLED TRIAL (NAVIGATE)

Digital recruitment methods represent tremendous opportunities for research, yet the practical realities reveal mixed results in the literature. Recruitment to Navigate, a trial evaluating a web-based Decision Aid for men with low-risk prostate cancer, has been challenging due to a narrow eligibility criteria, limited intervention delivery time and barriers of clinician engagement. Recruitment was a two tiered approach incorporating traditional (clinician referral) and digital (patient self-referral) methods. Methods Traditional and digital methods were compared for effectiveness and efficiency. Multimedia and digital promotion strategies (Fig.1) ; paid online advertising (Google Ads, Facebook) and the digital journey of a prostate cancer patient (Fig. 2) were also evaluated.

Website analytics of www.navigateprostate.com.au demonstrated increased traffic (41,000 unique views); improved user engagement; and 80% reduction in cost-per-recruit using targeted paid advertising (Table 1) . Clinician referrals using traditional methods accounted for the most recruits (87%) compared to online patient self-referrals (13%).

Traditional methods were more successful in recruiting men newly diagnosed with prostate cancer, however digital methods were beneficial to improve recruitment rates and raise awareness about the trial. Targeted paid advertising reduced costs-per-recruit. Successful strategies depend on trial design; digital marketing campaigns and online health-seeking behaviour of the target population.

Oral chemotherapy non-adherence compromises the efficacy of cancer treatment and may result in poor outcomes. Mobile phone-based interventions have shown to improve medication adherence in several chronic diseases. However, evidence in improving adherence to oral chemotherapy is lacking. We describe findings from a feasibility study of a novel smartphone-based tool to support adherence to non-hormonal oral chemotherapy. Methods A single-arm feasibility study was conducted in six Australian hospitals over a 10-week period. Data collection included baseline and postintervention oral chemotherapy adherence (self-report and Medication Event Monitoring System devices), knowledge about oral chemotherapy treatment, presence and severity of adverse effects and, satisfaction with and acceptability of the intervention.

Of 22 participants who consented to the study, 50% were female with age range 17-74 y/o. High acceptability of the smartphone tool saw with 64% of eligible participants consenting to the study and 95% completion rate. Satisfaction with the intervention was high (≥75%) and increased knowledge of medication was found post-intervention. Most of the participants (76%) were adherent at baseline and no changes were observed postintervention from self-report. An increase in side-effects presence and severity was observed post-intervention.

This smartphone-based intervention was found to be feasible when implemented in oncology settings with high acceptability and satisfaction amongst patients taking oral chemotherapy.

Patients with head and neck cancer (HNC) carry a significant symptom burden, function alterations, and decreased quality of life. Patients may suffer undue anxiety because they find treatment incomprehensible, which is partially a function of limited, understandable information. Patients' perceptions of obtaining adequate information prior and during treatment are predictive of positive outcomes. Compared to usual care, decision aids (DAs) may increase patients' knowledge, accuracy of risk perception, and congruency between values and care choices allowing them to partake in active decision-making.

A scoping review evaluated the range and nature of electronic DAs researched and/or trialed for patients with HNC. Six databases, reference lists and grey literature were searched from January 2010 to 2021. Articles on electronic DAs for oncology patients were searched then further sorted by specificity for HNC.

The search returned 4217 articles for oncology but only 167 for HNC. Twelve articles met inclusion criteria and were incorporated in the analysis. Five DAs have been created with varying design characteristics but four consistent themes.

Findings demonstrate the paucity of electronic DAs for patients with HNC and confirms that patient-centered decision-support, with visual images, may increase understanding of treatment options and risks to improve satisfaction with their decision and consultation, while reducing decisional conflict.

Timely intervention on patient-reported symptoms improves both quality of life (QoL) and quality of care. We implemented an application to monitor symptoms in lung cancer patients. The current goal is to refine the method for monitoring to optimise symptom management.

Patients complete a weekly 12-item symptom list from diagnosis until ≥1 year of follow up or death. The application is linked to the PROFILES infrastructure and provides personalized feedback about symptom burden, medication adherence and QoL in longitudinal graphs. Alerts are generated if a symptom exceeds a threshold (CTCAE ≥grade 3). The application is currently tested in the SYMPRO trial, comparing an active (nurse led) or re-active (patient-initiated) approach for responding to alerts. In a subsequent cohort of lung cancer patients, a personalized dynamic symptom list is used during systemic therapy, enabling comparison to the predefined and static 12 symptomssubset.

The application is currently used in 13 Dutch hospitals and in March 2021 457 patients have been enrolled. Since implementation required specified approaches per hospital, we followed an adaptive implementation strategy. Lessons learned and best practices for monitoring will be presented at the conference.

Following successful implementation for lung cancer, the SYMPRO method is currently implemented for other cancers too. Future use of the same data protocol regardless infrastructure for data collection, and also multidisciplinary collaboration is expected to optimize symptom management for Dutch cancer patients. 

Oncological healthcare services are challenged by the increasing number of cancer survivors, long-term follow-up care, and fragmentation of care. Digital care platforms (DCP) (figure 1.) are potential tools to deliver affordable, patient-centered oncological care. Objective This systematic review aimed to collect the best available evidence of the effect of a DCP on quality of care for oncological patients by focusing on enhancement of available information, self-efficacy, continuity of care, and patient-and healthcare provider-reported experiences. Additionally, barriers and facilitators for implementation of DCPs were analyzed. Methods PubMed (Medline), Embase, CINAHL and Cochrane Library were searched between January 2000 and May 2020 for eligible studies. Synthesis of the results was performed qualitatively. Mixed Methods Appraisal Tool was used for critical appraisal.

Seventeen studies were included for analysis. Usage of a DCP appeared to enhance the availability of information and self-efficacy. No data on the effect of DCP on continuity of care was found. Patient-reported experiences were positive. Most barriers for implementation were identified on the professional level and most facilitators were found on the patient and innovation level.

Despite the favorable results, robust evidence concerning the effectiveness of DCPs, especially from high-quality studies, is still lacking. Future studies should aim to further investigate the effectiveness of DCPs, and barriers and facilitators on the economic and political level.

This integrative review (1) characterizes the types and combinations of behavior change techniques (BCTs), (2) determines the ratio of BCTs delivered via mHealth to those incorporated, and (3) compares BCT components between effective and ineffective mHealth-enhanced physical activity (PA) interventions for breast and gynecological cancer patients.

Searching two English and two Chinese databases yielded 3,071 articles-16 met inclusion criteria. Intervention elements were coded independently and confirmed by YW and JMP using BCT taxonomy(V1) and a review matrix.

Chord diagram shows the types and combinations of BCTs across the interventions, which incorporated 17.8 (of 93) techniques, 10.3 of which were enacted by mHealth technology. The most common BCTs were self-monitoring of behavior, goal setting (behavior), and credible source. The ratio of BCTs delivered by technology to those incorporated in the intervention varied, from 0.24 to 1. Typical BCTs used in the interventions but not delivered by technology were problem solving and adding objects to the environment. Ineffective interventions were less likely to include the BCTs review outcome goal, graded tasks, and behavior demonstration.

The full range of BCTs was not reflected across the studies-most used technologies for practical purposes (i.e., information and monitoring). Subsequent research should consider the potential of mHealth technology to integrate and deliver a wider range of BCTs in PA interventions to improve outcomes among breast and gynecological cancer patients. 

There is literature hinting at the need to recognize that case presentation needs to adopt a perspective that is inherently different from the traditional problem-based approach. Methods This review is based upon the author´s personal experiences during postgraduate training.

The following issues need to be discussed in further detail -Disclosure of clinical diagnosis at outset, academic merit in exploring psychosocial issues, place of discussion (given the ethical ambivalence in discussing treatment options at bedside), discussion on cancer-directed treatment (extent of engagement with medical oncology topics), nature of formulation of differential diagnosis (appropriateness of listing non-cancer diagnosis), need for a pre-session briefing with family members (when the discussion is supposed to involve the patient directly) and purview of specialist palliation (whether engagement with home-care based problems, complex psychological issues, and nursing issues signifies tier three of training?).

Components that are integral to the practice of palliation need to be incorporated into the classical format, without compromising on an indepth bedside discussion on medical issues, central to comprehensive management of a cancer patient. Involvement of faculty from medicine and oncological specialties, inter-departmental rounds, and regular attempts at assessment of degree of concurrence of points discussed during the case conferences with topics in the curriculum holds the key to ensuring the growth of superior quality academics.

Oral Proffered Paper: CONSUMER ENGAGEMENT TOOLKIT: PRACTICAL TOOLS FOR MEANINGFUL INVOLVEMENT

The Victorian Comprehensive Cancer Centre (VCCC) is a powerful alliance of 10 research, academic and clinical institutions working together to accelerate and amplify cancer research, knowledge and expertise. Actively embedding the consumer perspective into program design and delivery remains a challenge and instigated development of a strategy for consumer engagement. Methods Semi-structured interviews with consumers and staff (n=53) were conducted to develop a model applying the Cancer Australia capability framework that outlines five levels of engagement (consumer-led, partnership, involving, consulting, informing). Consultation identified a need for articulating defined roles, mechanisms of engagement and supplementary resources to support implementation.

The resultant VCCC Model of Consumer Engagement describes consumer activities across diverse programs (for example, clinical trials, translational research, education and training) and is a guide to adopt training, communication and remuneration required to support effective engagement. An open access online portal, VCCC Consumer Engagement toolkit (1), supplements the model with case studies and resources that can be customised for broader use. Following launch of the toolkit in December 2019, over 8,500 pageviews and 1,300 downloads have been recorded.

The toolkit usage metrics demonstrate a need for resources to strengthen capability and establish quality partnerships that benefit the community and improve health outcomes. (1) 

Team process skills, essential in supporting patients with cancer via a multidisciplinary (MD) approach, are largely learned on-the-job. The Sartore Studentship in Supportive Care is a competitive six-week interprofessional (IP) elective which challenges two students per iteration to 'see through patients' eyes'.

At baseline, end of rotation, and six months, the Interdisciplinary Education Perception Scale (IEPS) and Attitudes to Health Professions Questionnaire (AHPQ) are administered. The IEPS (18 items) measures competency within one's own profession, perceived need for IP cooperation, and willingness to understand contributions of others. The AHPQ (20 items) measures attitudes towards other disciplines, via caring and subservient subscales.

Over 10 years, from 150 applicants (14 disciplines), 20 students completed the Studentship: 7 from Medicine, 3 Occupational Therapy, 2 Clinical Nutrition, 2 Physiotherapy, 2 Nursing, 2 Pharmacy, 1 Speech-Language Pathology and 1 Clinical Psychology. At elective's end, students typically report a more positive view of MD practice, seeing others as both more caring and more subservient compared to baseline. Students also describe a better appreciation for the cancer journey, with most expressing personal growth from their experiences. Quantitative analysis is ongoing.

Our IPE MDT studentship is feasible, successful, and generalizable to other academic settings. Trainees practice team-process and clinical skills which are transferable to future placements and ultimately post-licensure practice. Despite the global burden of cancer and vital role of cancer family caregivers, dietetics students typically receive little education and training related to cancer survivorship. The purpose of this qualitative study was to explore the effect of a cancer survivorship community-based learning (CBL) project on dietetics students' approaches to nutrition supportive care for families experiencing a cancer diagnosis.

In partnership with American Cancer Society's Hope Lodge, dietetics students in a Community Nutrition course developed electronic newsletters, recipes, and social media posts that shared evidence-based food, nutrition and wellness information to families who have experienced cancer. Students completed project evaluation surveys before and after course completion. Open-ended questions asked students to describe their approach to nutrition-related supportive care for families who have experienced cancer; answers were analyzed using inductive thematic analysis.

Twenty-nine students completed pre-and post-course evaluations. Four themes emerged from pre-course survey analysis: nutrition education, tailored food/culinary programming, support groups, and dietary counseling. Analysis of the post-course evaluations yielded four new themes: inclusion of caregivers/family, social support, culturally effective education, and needs assessment.

Cancer survivorship-focused CBL can be effective in expanding dietetics students' knowledge and priorities regarding nutrition supportive care in cancer.

Tobacco use is the greatest preventable cause of death, as it kills more than seven million people every year globally. Cigarette smoking is a significant contributor to cancer-related mortality, all-cause mortality and cancer recurrence. Furthermore, cigarette smoking reduces the response rate to cancer treatment, while increasing treatment-related toxicities. Methods A literature review was performed to identify the benefits of tobacco smoking cessation in patients with cancer, the harms associated with continued tobacco smoking in patients with cancer, and the use of pharmacotherapeutic interventions to help cancer patients quit smoking.

Smoking cessation can reduce cancer death rate by 30-40%, which is as good as or better than many cancer treatments. Studies have demonstrated the improved overall survival of patients with cancer who stopped smoking upon diagnosis. In addition, cigarette smoking can significantly reduce the bioavailability of some cancer medications, including erlotinib and irinotecan. Continued cigarette smoking may increase the risk of complications and mortality, associated with radiation therapy and surgery. Up to one-third of patients diagnosed with cancer are able to successfully quit smoking through counselling and pharmacotherapy. Combination therapies are more effective than monotherapy in achieving abstinence.

It is never too late for patients with cancer to consider quitting, particularly once they are better informed about the negative consequences of continuing to smoke tobacco.

EDUCA-06 "THE NAUSEA CARD GAME"-AN EDUCATIONAL TOOL IN DAILY CLINICAL PRACTICE","LOUISE.BAGER.03 @REGIONH.DK",""THE NAUSEA CARD GAME"-AN EDUCATIONAL TOOL IN DAILY CLINICAL PRACTICE

Oncology nurses play an important role in symptom management related to chemotherapy induced nausea and vomiting (CINV). Thus, it is of great importance that nurses have evidence-based knowledge on CINV. The aim of present study was to investigate whether "The Nausea Card Game", educational tool can increase the knowledge about CINV among nurses specialized in oncology and to gather feedback on the content of the game.

In a pilot study, nurses treating patients receiving chemotherapy tested "The Nausea Card Game". The content of the game is based on MASCC guidelines for antiemetics, antiemetics product summaries and best practice guidelines, consisting of 4 categories: pharmacology, pathophysiology, anamnesis and patient cases. Visual-and game design were developed by a professional illustrator and game designer. Participants were instructed to play the game, for a period of 3 weeks, a minimum of 3 times a week, during their shifts, either alone or multiplayer. At baseline and evaluation participants answered a 9-item questionnaire to evaluate their knowledge of CINV. At evaluation additionally 3 questions were asked to evaluate the experience of playing the game and an optional write in section for feedback on specific content. Results 33 nurses, from 6 oncological departments in Denmark were included. The participants had an average of 7 years (1-15) of experience in working with CINV. Data evaluating "The Nausea Card Game", educational tool is currently undergoing assessment and further results will be presented at MASCC 2021.

S. Banerjee 1 1 Burdwan Medical College and Hospital,Burdwan, Howrah, India

To assess the available evidence on sentinel lymph-node biopsy, and to examine the long-term follow-up data from large randomized phase III trials comparing breast-conserving therapy with mastectomy in order to make recommendations on the surgical management of early invasive breast cancer (stages I and II) including the optimum management of the axillary nodes: for the breast -MRM vs BCT.

We searched MEDLINE (1966 ( -April 2004 , EMBASE (1980 ( -April 2004 and the Cochrane Library (issue 1, 2004) . The strategy used disease-specific terms in combination with treatment-specific terms (mastectomy)or breast conserv (tw) or sentinel [tw] or axilla [tw] ) and terms specifically for study design and publication type (meta-analysis [pt, sh, tw] or randomized controlled trial [sh, pt, tw] or randomized controlled trials/ or random [tw]).

Overall survival, disease-free survival, local recurrence, distant recurrence and quality of life. Evidence MEDLINE, EMBASE, the Cochrane Library databases and relevant conference proceedings were searched to identify randomized trials and meta-analyses. Two members of the Practice Guidelines Initiative, Breast Cancer Disease Site Group (BCDSG) selected and reviewed studies that met the inclusion criteria.

Women who are eligible for breast-conserving surgery should be offered the choice of either breast-conserving therapy with axillary dissection or modified radical mastectomy. There is promising but limited evidence to support recommendations regarding sentinel lymph-node biopsy alone. Social Media have increasingly been incorporated into healthcare and medical education, and various platforms are being employed by healthcare professionals and professional societies to connect members of different specialties across continents, facilitating idea-sharing through collaboration, interaction, and discussion, enhancing communication, and education.

The Multinational Association for Supportive Care in Cancer (MASCC), the leading international association for supportive oncology, and its Hemostasis Study Group, band professionals interested in cancerassociated thrombosis and hemostasis. A WhatsApp social media group was created on June 24, 2019, as a tool to increase engagement, promote collaboration and exchange of ideas among its members in real-time.

Since its creation, the group has posted 93 articles and documents, 45 links, and 26 photos of presentations at congresses. It facilitated the exchange of literature and revision of manuscripts during the development of the Clinical Practice Guidelines for the Prophylaxis of Venous Thromboembolism in Hospitalized Cancer Patients. Additionally, it was instrumental in maintaining its members updated on the successes at the height of the COVID-19 pandemic at different latitudes around the globe. Conclusions Social Media, and in particular WhatsApp, has allowed members of the MASCC Hemostasis Study Group to facilitate conversations across the globe, exchange of medical literature, and enhanced learning and education, by the rapid dissemination of ground-breaking results. Introduction Cannabidiol (CBD) is purported for a variety of therapeutic indications. Interest in CBD products have significantly increased over the past years as cancer patients seek ways to improve symptom control and quality of life. The purpose of this study was to explore patients' knowledge and experience with CBD. Methods A panel of oncology nurse practitioners, an oncologist, and oncology pharmacy specialists developed a survey to capture information about cancer patient knowledge and use of CBD. The initial survey was pilot tested and further refined resulting in the final item survey. The final survey was administered to 100 subjects undergoing or having completed cancer treatment and being followed in a supportive oncology care clinic at a large academic medical center.

Most patients (47%) learned about CBD through a family or friend. The majority of patients (69%) had never tried CBD. The most common reported indications were pain (84%), anxiety (35%), and nausea (29%). Of those who have not tried CBD, the most common reasons included lack of knowledge about CBD (32%) and providers not recommending CBD (7%).

Patients learned about CBD thru many sources outside of their oncology team and over 30% of patients have tried CBD in oncology.

In order to cultivate clinical specialist nurses in the field of palliative care and promote the practice of palliative care in mainland China, the first training of Chinese palliative care specialist nurses was started in September 2019. The purpose of this training was to build a training program suitable for Chinese palliative care specialist nurses. Methods 192 trainees from 27 provinces (municipalities) in China were trained as specialist nurses in palliative care. The training program included one month of concentrated theoretical learning and one month of clinical practice. The training effect was evaluated by theoretical examination, clinical practice examination, comparison of knowledge, attitude and behavior concerning hospice care between students before and after training and survey of the satisfaction of students.

All trainees passed theoretical and clinical practice examinations. Their knowledge, attitude and behavior concerning palliative care were significantly improved after training (p< 0.001). The overall satisfaction rate towards the theoretical courses was 95.6%, and the overall satisfaction rate of towards the clinical teaching base was 94.2%.

The centralized training can ensure the trainees to acquire basic professional knowledge and skills and improve their knowledge, attitudes and behaviors concerning palliative care. However, it is needed to explore training programs that are in part-time model, delivered online or suitable for different levels of nursing staff to improve the accessibility.

Given the novelty of Chimeric Antigen Receptor T-cell (CAR-T) therapy, there are knowledge gaps in how the palliative care (PC) interdisciplinary team (IDT) can manage CAR-T-specific concerns. In advance of published research, social media can be used to crowdsource real-world insights and support clinical care. This study aimed to assess the impact of an educational session on the IDT's attitudes on using Twitter for professional development and clinical care. Methods Tweets from January 1st, 2017 to December 31st, 2019 were sampled by searching "CAR-T" and used to create a 60-minute lecture on themes identified by medical team members and patients/caregivers. The Dartmouth-Hitchcock Medical Center PC IDT were surveyed via SurveyMonkey to evaluate their attitudes toward Twitter before (n=33) and after (n=16) the lecture. Mann-Whitney U test was employed.

Before the lecture, 6% of respondents agreed that Twitter could help with professional advancement, and 9% agreed it could improve patient care. Post-lecture, 25% agreed with both statements (p=<0.05), and half of surveyed (n=8) considered further exploring Twitter. Key themes identified on Twitter by team members included financial toxicity, quality of life, prognostic uncertainty, and limited access. Patients'/caregivers' concerns included delays in therapy, ambivalence about side effects, managing emotion, balancing family needs, and spiritual/religious support.

Education may improve the recognition of Twitter as a resource to support clinical care for patients undergoing novel therapies.

Hospital Dentistry (HD) is considered a dentist speciality in Brazil and is responsible for oncology patients' oral care. Still incipient, but fundamental for complex patients such as the oncological patient. Despite its legitimacy since 2004, its insertion within universities and dentistry students' sensitisation remains a cornerstone. Objectives Evaluated Dentistry students' perception and attitudes before and after taking an extension course of intrahospital oncology care Methods A qualitative study was carried out employing a semi-structured questionnaire (9 questions) applied in two periods of the course: pre-course phase (F0) and post-course phase (F1). A total of 19 participants, belonging to the 3rd and fourth academic year, with no previous knowledge in oncology care, answered the questionnaire(4 domains: protocols oral care; mucositis, quality of life; interprofessional care). Qualitative analysis using the Likert scale (poor: 1; neutral: 2; good: 3; excellent: 4). Obtained 19 respondents, predominantly female (68%), average age (21 years). The average pre-course (F0) score was 13 and post-course 31 (p <00.1). The insertion of Dentistry students in oncological patients' management through an extension course during graduation allowed the displacement of knowledge and positive attitudes of these students in patient-centred care and not just in the disease or restricted to the oral cavity. "Health literacy is a clear, fair, understandable discussion with the patient. When complex concepts, such as precision medicine in oncology, emerge, the caregivers lack expertise in their exchanges. Onco Partage association relies on health literacy and propose a specific program dedicated to personalized medicine. The project consists of an inventory of the knowledge of patients and caregivers through a mirror survey followed by a brainstorming and dedicated tools construction. Between May and June 2020, 92 responses to the survey pointed out a lack of knowledge of caregivers. Patient requests individual sessions about this fuzzy notion. Their information most often comes from nonprofessional sources and cannot decrease their anxieties. Brainstorming led to split the notion of personalized medicine into 5 axes. A common methodology to all axes was established. It involves a script with an adapted vocabulary; a validation by a scientific committee; a production of a video with a careful choice of images; a patient file, an interactive TPE; then training and educational pilots. Today the video of the first axis: "What is a molecular test?" is undergoing regional testing before a national distribution. The intrinsic value of the project is done using questions associated with the video. Precision medicine is a complex notion for patients but also for caregivers. After an inventory, we build a specific TPE to facilitate the task of caregivers and reduce patient anxiety"

Lung cancer is among the five main types of cancer leading to overall cancer mortality contributing about 1.3 million deaths/year globally. Pulmonary symptoms of lung cancer cause stress, loss of physical stamina, so that even activities of daily leaving (ADL) became difficult or even impossible. Saint George Respiratory Questionnaire (SGRQ) measures the respiratory disease-specific health related quality of life. The aim of this study was to determine the concurrent validity of SGRQ with Chronic Respiratory Questionnaire (CRQ) and Short Form-36 (SF-36) in lung cancer population.

This descriptive cross-sectional study included 34 lung cancer subjects who were asked to fill Health Related Quality Of Life (HRQOL) questionnaires (SGRQ, CRQ and SF-3) and the concurrent validity of SGRQ was validated with Spearman's correlation test.

High negative correlation was found between SGRQ and CRQ (r = -0.826, P < 0.05), and between SGRQ and SF-36 (r = -0.697, P < 0.05) as well.

The established concurrent validity of SGRQ is excellent and it can be used for screening the HRQOL in lung cancer population and also can be as an alternate for other time consuming discriminating measures used for measure HRQOL.

Cancer care is becoming more complex with scientific advances in tumor markers, early detection, and new treatments. Toxicities related to targeted therapies, improved survival from cancer and comorbid medical conditions have contributed to a growing need for internists who have the expertise in the unique medical needs of cancer patients. Our goal was to integrate oncologic exposure into an internal medicine residency and subsequently develop a pathway into oncomedicine.

The Division of Internal Medicine at MD Anderson Cancer Center partnered with Baylor College of Medicine to develop a joint Internal Medicine Residency Program managed as a separate track in June 2015. The 3 year program has 5 resident slots per year for a total of 15 residents at any one time. At least half of Baylor Internal Medicine residents rotate through the cancer center for at least one month while trainees on the combined track spend one third of their time at the cancer center.

By July 2021, 20 residents will have graduated from the track and approximately 55% will be working in a cancer center. In these 6 years 5 graduates not on the track have also been hired as hospitalists at a cancer center.

The combined track has increased oncomedicine exposure for the entire residency. The majority of graduates from the track have pursued careers in cancer care. Given these encouraging results, our model may be applied to other programs to increase training and exposure to oncomedicine.

Breast cancer patients may have a smoking history, and there are documented negative impacts of smoking on the body. Radiotherapy (RT) is standard treatment practice and may increase free radicals and/or oxidative stress to the body. Limited studies discuss combined effects of these exposures. This systematic review explores effects of smoking on clinical outcomes after adjuvant breast RT.

Ovid MEDLINE, Cochrane Central Register of Controlled Trials and Embase were searched using keywords. Studies comparing smokers and non-smokers for clinical outcomes after adjuvant breast RT were included. Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed ( Figure 1 ). After relevance screening, data was gathered from 71 articles.

Outcomes after RT were grouped into six categories: skin reactions, reconstruction outcomes, secondary carcinoma, mortality, pulmonary and cardiovascular impacts ( Table 1) . Within these categories, 198 varied outcomes were analyzed between smokers and non-smokers. Significant difference was seen in 79 (40%) of outcomes ( Table 2 ). Not all articles reported worse outcomes in smokers, yet no studies found smokers with better results than non-smokers. Radiation dermatitis is a common adverse effect of radiotherapy (RT) in breast cancer patients. Studies have shown disagreement between clinician-reported outcomes (CROs) and patient-reported outcomes (PROs). The purpose of this systematic review and meta-analysis was to evaluate the level of agreement between CROs and PROs of acute and late skin toxicity for breast cancer patients receiving external beam RT.

Ovid MEDLINE, Embase and Cochrane Central Register of Controlled Trials databases were reviewed using keyword search. Studies evaluating skin toxicity from external beam RT were included. Toxicities were classified as acute (<3 months after RT) and late (>3 months after RT).

Nine studies were included in the systematic review and 8 studies were included in the meta-analysis. There was agreement between CROs and PROs of acute skin colour change, fibrosis and/or retraction and moist desquamation (p>0.005). Late breast pain, breast edema, skin colour change, telangiectasia, fibrosis and/or retraction and induration/fibrosis were also in agreement (p>0.005). There was greater patient-reported acute breast pain (p<0.001) and breast shrinkage (p=0.005) and greater clinician-reported acute breast edema (p<0.001).

Given discrepancies between CROs and PROs, both measures should be reported in future studies. Development of a single tool to assess symptoms from both clinician and patient perspectives is advocated.

In order to help women treated for gynecological cancer to overcome sexual issues, nurses must initiate discussion about sexual health. The most common barrier to sexual health discussion is the lack of training and limited knowledge of sexual health. The aim of this presentation is to describe different educational interventions available to improve nursing communication on sexual health with women living with gynecological cancer. Methods A literature narrative review was conducted in the Medline, CINAHL and PsycINFO databases between 2010 and 2020. Data were extracted by two independent reviewers and analyzed using the Template for intervention description and replication (TIDieR) checklist and guide.

Eleven studies were selected. Results showed that interventions were very heterogeneous in terms of learning modalities, learning subject and activities, trainers and duration. No intervention was developed for the gynecological cancer clientele. Although an improvement in knowledge and self-efficacy, the effect of some interventions on nursing attitudes and communication skills still not clear.

Our narrative review replicates previous findings and highlights the lack of educational intervention for nurses working with gynecological cancer clientele. Additional interventions should be developed specially for these nurses to meet their specific learning needs and to better address sexual concerns of gynecological cancer clientele. 

Drugs play an important role in treating illnesses and maintaining health, but they may have adverse reactions compromising the quality of life in patients with cancer. Adverse drug reactions and drug-drug interactions are a common problem in medical practice. Patients with cancer are more vulnerable due to the multiple medications they are taking. A sound knowledge of drugs' adverse reactions is essential to all clinicians involved in cancer care. Methods A retrospective chart review of patients with adverse drug reactions was done. Knowledge was further enhanced by in depth reading of drugs' side effects, route of metabolism and interaction with other drugs on board. A case study will be presented of a patient who lost her independence, control of her life savings and decision making capacity due to adverse drug reaction.

Increased knowledge and education about adverse drug reactions/drug interactions will result in better management of oncology patients. Clinicians will improve vigilance in choosing medications based on patients' age, vulnerability, physiological status and other medications taken. This will also help in recognizing any adverse reactions compromising patients' mental or physiological status.

Education of all clinicians about the impact of adverse drug reactions and promotion of enhanced pharmacovigilance results in better management and improved quality of life for oncology patients. Reduction of adverse drug reactions may lead to reduced inpatient days and lower healthcare costs.

Flipped classroom has been currently used as an educational tool to enhance the educational experience. Using this tool would in oncology trainees could enhance learning and potentially provide another modality of presenting a learning material to learners. Methods I did develop a Power-point presentation of teaching for renal cancer management for oncology/hematology fellows at our institution. Presentation slides were sent to fellows one week prior to the educational event. They were informed that the event would be used to review the material and answer questions /review practical aspects in the management of patients with RCC. they were encouraged to bring clinical cases for discussion. Results 9 fellows participated in the event, 5 fellows completed a survey post the event. they answered 3 questions; 1. what did you learn? 2. how different is this learning from other events 3. what is your learning style? Several themes include " learner were able to learn from each other during the sessions, less material covered than a standard lecture, engagement of all learners during the session, more enjoyable, everyone was able to know their strength and weaknesses, active learning, easier to learn and more interaction". this also provided time to explore opportunities to learn about the topic and help them think about this as a potential tool for them for teaching.

Hematology/ Oncology fellows had a favorable experience with flipped classroom teaching. Based on their perceptions this improved and enhanced their learning and was more action oriented. 

Cannabis is used by some cancer patients to self-manage certain of their symptoms (e.g. nausea). To optimize the clinical intervention of nurses in this context, this mixed methods study aims to assess oncology nurses' perceptions of the benefits of an educational intervention to support the safe use of cannabis with young adults with cancer (i.e. knowledge, perceived behavioral control, and intentions), its feasibility, and its acceptability.

First, a two-arm pilot randomized control trial will be conducted. Nurses will be allocated to an educational intervention (n=30) or a control group (n=30) with two measures (i.e. baseline and after the intervention). Subsequently, qualitative interviews will be conducted with nurses (n=12) about their perceptions of the benefits of the educational intervention, its feasibility, and its acceptability then analyzed using an iterative thematic approach. Quantitative data collection will include data about the recruitment and a self-administered Likert scale questionnaire on nurses' knowledge, their perceived behavioral control, and their intentions. Descriptive analysis and T-test will be performed.

It is expected that this study will provide data regarding nurses' perceptions of the benefits of the educational intervention, its feasibility and its acceptability.

This intervention could benefit oncology nurses who provide care to young adults with cancer about safe and efficient use of medical cannabis.

Chemotherapy induced nausea and vomiting (CINV) is a major side effect for all cancer patients undergoing chemotherapy. This study aims to evaluate the impact of patient education on antiemetic medication compliance and hospital readmission rates for CINV following the administration of moderate to high emetic risk chemotherapy.

In this cross-sectional cohort quality improvement study, all patients admitted to a single acute care hospital for chemotherapy with a moderate to high emetic potential regimen over a 3 month period were randomized 1:1 to receive patient education or not. All patients were contacted via telephone approximately 7 days after completion of chemotherapy to assess for CINV symptoms and medication compliance. Data was analyzed using a chi-squared test.

A total of 89 patients were randomized, 47 (52.8%) of which received education and 42 (47.2%) did not. After randomization, 26 patients (29.2%) were lost to follow up. The difference in the primary outcome of medication compliance was not statistically significant between the study groups (46.8% vs 35.7%, P=0.29). The difference in the secondary outcome of hospital readmission also did not reach statistical significance (P=0.29).

This study did not demonstrate a statistically significant difference in medication adherence or hospital readmission rates after providing patient education for CINV during an inpatient admission for chemotherapy. 

Cancer-related fatigue (CRF) affects more than 90% of patients and may be exacerbated by common metabolic disorders, for example diabetes.

Analyses are based on data from a prospective nationwide longitudinal study of female breast cancer patients undergoing chemotherapy and female age-matched controls without cancer. CRF was measured using the Multidimensional Fatigue Symptom Inventory (MFSI) before, immediately post-, and 6-months post-chemotherapy in patients and controls (at equivalent time points). Diabetes diagnosis was obtained from the medical record at baseline. Repeated measures mixed models were used to model CRF over time controlling for cancer (y/n), age, race, and body mass index.

Diabetes was twice as prevalent among patients with cancer than controls (p=0.007, Table) . Patients had worse fatigue than controls throughout treatment (p<0.001; Figure) . Diabetes was associated with worse fatigue with a clinically meaningful difference of 6.2±2.4 points in all

So far fatigue has been assessed predominantly in breast cancer patients. Comparative investigations across a broad range of entities are lacking.

The FiX study systematically enrolled 2,244 cancer patients across 15 entities two years after diagnosis. Physical, emotional, and cognitive fatigue were assessed with the EORTC QLQ-FA12, compared across entities as well as with normative values of the general German population. Analyses of covariance were performed to investigate differences between entities taking patients' characteristics and cancer therapy into account.

Compared to the general population fatigue was higher in cancer patients across all entities and all fatigue dimensions. Age-and sex-standardized prevalence ranged from 32% to 52% for physical fatigue, and from 30% to 49% for emotional fatigue. After adjusting for age, sex, BMI, and cancer therapy, mean fatigue levels still differed significantly between cancer entities, with physical and emotional fatigue being lowest among breast cancer patients, and highest among stomach, bladder, and rectal cancer patients.

About two years after diagnosis, physical, emotional, and cognitive fatigue is still prevalent in all 15 investigated entities. For most entities fatigue levels were above those of breast cancer patients, the so-far most investigated group, suggesting that the extent of fatigue has not been fully explored to date. Entity-and therapy-specific issues need to be considered to improve fatigue treatment.

Women with gynecologic cancers (GynCa) report multiple co-occurring symptoms known as psychoneurological symptoms (PNS) cluster. PNS cluster includes pain, fatigue, depression, sleep disturbance and cognitive dysfunction, which may have a detrimental impact on quality of life (QoL). This study identified the stability of PNS over time and its association with QoL in GynCa patients treated with radiation therapy (RT).

In this secondary data analysis, women with GynCa completed PNS assessment data at pre-RT (T0), six weeks (T1), and six months (T2) after RT. Pain, fatigue, depression, sleep disturbances, and cognitive impairment were measured using FACT-G. The EQ-5D was used to measure QoL. An average score of the five symptoms was computed as the total score of PNS cluster. The Friedman test was performed to evaluate change in the PNS cluster over time. A mixed effect model explored the associations of PNS cluster with QoL.

Forty-six GynCa patients' demographics were: mean age (58.3 years), African-American (47%) and White (41%), non-Hispanic (72%); cervical (54%) and endometrial cancer (46%) and Stage I-II disease (78%). Almost all patients (96%) had at least two PNS at every time point. Across the three time points, the PNS cluster did not change significantly. QoL was associated with PNS cluster and BMI.

The PNS cluster was present in most patients treated for GynCa and remained stable across RT. Results also identified that obesity and PNS cluster are associated with QoL, thus warranting further study to confirm the findings. 

The growing awareness of the complexity of cancer-related fatigue (CRF) and its disruptive impact on cancer patients' outcomes, has significantly boosted researchers' attention. As a result, fatigue literature encloses multiple systematic reviews (SRs) and meta-analyses on pharmacological interventions for improving CRF, resulting in redundant and fragmented evidence. Thus, we critically appraised all the available SRs on pharmacological intervention for improving CRF in adult cancer patients.

The study is a systematic review of SRs conducted according to Cochrane's recommendations. Three databases were systematically searched from January 2010 to July 2020. ROBIS tool evaluated the risk of bias of the eligible SRs. The meta-analyses' effect sizes (standardized mean difference, SMD) were quantitatively pooled using a random-effects model. Chisquared (Q) and I-square statistics (I²) tested the heterogeneity.

Of 1228 articles, six SRs were considered for the final inclusion. The pooled estimate significant reduction in fatigue was SMD= −0.20 (95% CI: −0.33 to −0.08; p=0.0015), along with significant higher improvement of fatigue (SMD=-0.69; 95% CI=-1.29, -0,09) after methylphenidate administration. No statistical differences were found in the adverse events' occurrence between methylphenidate and placebo: RR=1.412, 95% CI -0.63-2.89.

Psychostimulants may be moderately effective in reducing CRF. Insufficient evidence on the short-and long-term adverse events emerged from our analysis. PROSPERO: CRD42020181879

Interdisciplinary acute palliative care units (APCU) are traditionally designed to provide care for patients who are approaching end-of-life. Here we present a challenging case of a patient with advanced non-small cell lung carcinoma referred to palliative care (PC) while receiving antineoplastic treatment. The patient could not undergo biopsy and radiation simulation due to uncontrolled pain. PC team promptly recognized the possibility of underlying psychosocial, emotional, and spiritual causes for the patient's total pain expression and transferred him to the APCU.

Edmonton Symptom Assessment Scale (ESAS) was used to monitor daily symptoms (Table 1) . Upon admission, the patient was started on continuous hydromorphone infusion due to the uncontrolled back pain (9/10). The interdisciplinary team members worked together to alleviate his total sufferings. Patient morphine equivalent daily dose (MEDD) was at its peak of 870mg. Later opioid rotation to oral methadone was introduced along with simultaneous decreases in the hydromorphone infusion over the next 3 days. On the 4th day, the pain was at an intensity of 5/10 and then was able to underwent a CT guided percutaneous biopsy of the adrenal gland, and eventually, radiation therapy was initiated. His discharge MEDD was 265mg, which was a 70% reduction from 6 days ago.

Patient was eventually discharged home under the care of oncology, and PC teams.

APCUs can be effectively utilized beyond their traditional role in patients with refractory symptoms.

Cancer-related fatigue (CRF) is a highly prevalent, debilitating, and persistent symptom experienced by patients receiving cancer treatments. Up to 71% of men with prostate cancer receiving radiaotherapy (RT) experience acute and persistent CRF. There is neither an effective therapy nor a diagnostic biomarker for CRF. This pilot study aimed to discover potential biomarkers associated with chronic CRF in men with prostate cancer receiving RT.

We used a longitudinal repeated-measures research design. CRF was evaluated by a well-established and validated questionnaire, the Patient-Reported Outcomes Measurement Information System -Fatigue (PROMIS-F) Short Form. Peripheral blood mononuclear cells (PBMCs) were harvested to quantify RNA gene expression of mitochondria-related genes. Data were collected before, during, on completion, and 24 months post-RT, and analyzed using paired-t tests and repeated measures ANOVA.

The mean PROMIS-F T-score was significantly increased overt time in patients with prostate cancer, remaining elevated at 24 months post RT compared to baseline (p < 0.01). A significant downregulated BC1 ubiquinol-cytochrome c reductase synthesis-like (BCS1L) was observed over time during RT and at 24 months post-RT (fold change > -1.5, p = 0.03). An increased PROMIS-F score was trended with downregulated BCS1L in patients 24 months after completion of RT.

Our results suggest that PBMCs messenger RNA for BCS1L is a potential biomarker and therapeutic target of bioenergetics for RT-induced CRF in this clinical population.

This study aimed to explore the effects of virtual reality (VR) based restorative activities on cognitive performance and perceived function in women who had cognitive complaints within two years after chemotherapy for non-metastatic breast cancer.

A double-blind pilot study was conducted to evaluate the effects of VRbased exposure to the natural environment for cognitive restoration in chemotherapy-treated breast cancer survivors with cognitive symptoms. Seventeen women received VR-based intervention for 4 weeks and a control group of 7 women received usual care. A computerized cognitive test battery and self-reported cognitive symptoms were assessed at baseline (T1), 4 (T2) and 8 weeks (T3). Repeated measures ANCOVA was performed to determine the pattern of change in cognitive function over time.

There were no differences between experimental and control groups at baseline. A significant group by time interaction on cognitive performance was found. The experimental group showed a gradual increase between T1 and T2 and plateau between T2 and T3 while the control group showed slight increase and then returned to T1, controlling for other adjuvant treatments. There was no significant group by time interaction on self-reported cognitive symptoms.

VR-based restorative activities can lead to improved cognitive performance of breast cancer survivors with cognitive symptoms after chemotherapy. This pilot study provides a feasible program that can be used to manage cognitive dysfunction after treatment. 

Fatigue is reported as the most distressing side effect of cancer therapy, negatively affecting physical function and quality of life in patients. Exercise is shown to be an effective intervention for reducing cancer-related fatigue (CRF); however, the effects of general physical activity remain unknown. This study explored the relationship between physical activity and perceived fatigue in men with non-metastatic prostate cancer (NMPC) receiving external beam radiation therapy (EBRT).

To measure physical activity, participants (N=57) wore an Actical accelerometer and completed activity logs four consecutive days at baseline, midpoint, and endpoint of EBRT. Perceived fatigue was assessed using the Functional Assessment of Cancer Therapy -Fatigue (FACT-F) at each timepoint.

Perceived fatigue worsened from baseline (43.09±9.26) to midpoint (40.14±10.08) and endpoint (39.64±9.73) of EBRT. There was no significant correlation between physical activity and fatigue, but patterns suggest a predictive relationship.

Identifying predictive factors of fatigue allows for timely education and intervention. There was an inverse relationship between physical activity and fatigue at completion of EBRT; therefore, a noticeable decrease in physical activity may be predictive of fatigue in men with NMPC throughout EBRT. Future studies should explore the long-term relationship between physical activity and fatigue following completion of cancer therapy .

Time-restricted eating (TRE) has emerged as a powerful practice to regulate energy levels but has not yet been evaluated in the cancer population. Herein, we evaluated the feasibility and safety of a novel 2-week TRE intervention with a 10-h eating window and tracked changes in fatigue from pre-to post-intervention.

We recruited survivors 4-60 months post-cancer treatment with fatigue ≥3/10. The TRE intervention was nutritionist-led and asked participants to eat all food and beverages within a consistent, self-selected 10-h window for 14 days; water was always allowed. Adherence was measured from daily diaries, and safety was assessed with weekly phone calls and body weight measurements. At pre-and post-intervention, participants completed the Brief Fatigue Inventory.

Participants ( 

Cancer-related fatigue at baseline and postintervention as measured using the BFI. A paired t-test was used to statistically assess differences between time points. Error bars depict standard deviation (n=19).

Less fatigue p<0.001 ES= -0.81

Effective symptom management is a critical component of cancer treatment. Prediction of symptom severity can assist clinicians with treatment regimens and interventions. Cancer-related fatigue (CRF) is the most common symptom associated with cancer and its treatments. CRF has a negative impact on the patients' ability to tolerate treatments and on their quality of life. One of the limitations to effective treatment of CRF is the availability of a valid and reliable model to predict the severity of CRF. In this study, we improve our pilot model using demographic and clinical characteristics and CRF levels collected just prior to chemotherapy (CTX) administration (T1) to predict evening CRF severity 1 week after (T2).

Recursive partitioning and regression trees (RT) and linear regression (LR) were used to predict the severity of evening fatigue at T2. We fit the models using repeated cross validation ( 

Cancer-related fatigue (CRF) is a burden to many people with cancer. Evidence based guidelines for CRF are not routinely used. This study aimed to evaluate feasibility of a CRF guideline at an Australian cancer centre.

A mixed methods study used multiple strategies to pilot the CRF guideline in five teams, using dedicated change agents. Teams included allied health, palliative care, one tumour stream, radio-and chemotherapy nurses. Survey, audit and qualitative data assessed acceptability, adoption, practicability and penetration of the guideline.

Implementation strategies were modified for different teams throughout the pilot. Feasibility was greatest in occupational therapy, chemo-and radiotherapy nursing, where fatigue management best aligned with existing practice. The online training was deemed acceptable, but uptake was limited to some allied health disciplines and several nurses. Active support by leaders increased training completion rates. Nurses who attended in-person training had greater adherence to guideline processes, compared to untrained nurses. Specialist nurses and doctors recognised a need for fatigue management, but lacked time to do the training or address fatigue in outpatient settings.

Fatigue management training should be mandatory and accessible for cancer health professionals, with support by team leaders. The guidelines were feasible in some pilot areas suggesting potential for allied-health led cancer fatigue management, and wider application is warranted. Cancer-related fatigue (CRF) is a prevalent debilitating condition with multifactorial etiology, also reported by pediatric oncology patients. No gold-standard treatment is approved for CRF due to insufficient understanding of underlying mechanisms. We aimed to assess the relationship of CRF and physical activity during therapy between boys and girls.

In twenty pediatric patients with mixed cancer (mean age=12.4±2.5 years; 8 female) PedsQLMultidimensional Fatigue Scale questionnaire was completed during cancer therapy. The standard treatment for pediatric patients was adjuvant chemotherapy according to national protocols. Physical activity during therapy was queried with questionnaire about type and duration of activity and was summarized in minutes of activity/week. Pearson correlations were used to analyze the data (α=0.05). Mean time between start of cancer therapy and CRF questionnaire was 101.3±35.7 days. For both boys and girls there was no statistical correlation between CRF and physical activity (boys r=0.491, p=0.105; girls r=0.631,p=0.094). However, the boys showed a significant correlation between CRF related to sleep/rest and physical activity during therapy (r=0.730, p=0.007). Physical activity has the potential to reduce CRF during cancer treatment in pediatric cancer patients. Exercise represents an effective therapeutic intervention for preparing children to successfully complete treatments, and for reducing acute side effects like CRF.

Breast cancer patients receiving adjuvant radiotherapy (RT) benefit from local control. However, RT can give rise to increased fatigue, lowering quality of life. The aim of this study was to identify trends and risk factors in patient-reported fatigue associated with breast RT.

Patients were assessed using the Edmonton Symptom Assessment Scale (ESAS) before, once per week during RT, up to 6 weeks after RT, and 1-3 months post-RT. Patients were eligible if the ESAS was completed before, at least once during, and at least once after RT.

A total of 651 patients were included. Fatigue increased significantly during weeks 1-4 and weeks 5-6 during RT compared to baseline (Table 1) . After RT, fatigue increased significantly during weeks 1-2, and 1-3 months post-RT compared to baseline (Table 1) . Mastectomy patients who received previous chemotherapy had significantly more fatigue compared to those without previous chemotherapy (Table 2 ; p=0.005). Patients less than 40 (p=0.0024), 40-49 (p<0.0001), or 50-59 (p<0.0001) years of age at RT start were more likely to be fatigued compared to patients ≥60 years of age (Table 3) .

Fatigue associated with breast irradiation increased up to 2 weeks after RT completion and remained above baseline at 1-3 months post-RT. Further research is needed to reduce fatigue, especially for those who have received previous chemotherapy, and younger patients who are receiving breast RT.

Fatigue is a frequent problem for cancer patients, which impacts negatively the quality of life (QOL) (1) . The aim of this study is to evaluate the relation between fatigue and QOL in cancer inpatients.

This study was carried out in Hacettepe Oncology Hospital. The Brief Fatigue Inventory (BFI) and The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) were of help to assess fatigue and QOL of patients.

This study included 31 cancer inpatients with a mean age of 52.61±14.73 years. BFI and EORTC QLQ-C30 scores were mentioned in Table 1 .

There were different levels of relationships between EORTC QLQ-C30 and BFI (Table 2) .

In our study, cancer inpatients had moderate fatigue severity, which was associated with QOL. Fatigue in these patients can interfere with daily activities, interpersonal relationships, and mood, resulting in a decrease in QOL. Fatigue and hospitalization may lead to therapy discontinuation, trouble managing symptoms, and poor treatment adherence. As a result, careful monitoring and management of fatigue in cancer inpatients can have a beneficial impact on QOL. 

Several symptoms like fatigue, depression, and anxiety accompanies cancer and its treatment (1) . Fatigue in hospitalized cancer patients can be exacerbated due to depression and anxiety. The aims of this study are to compare the severity of fatigue in hospitalized cancer patients with and without depression and anxiety, as well as to investigate the relation between fatigue, depression, and anxiety.

This study involved 31 hospitalized cancer patients with a mean age of 53.21±14.31 years. The Brief Fatigue Inventory (BFI) and the Hospital Anxiety and Depression Scale (HADS) were used to determine the severity of fatigue and the emotional disorder.

The fatigue severity of patients with depression (n=21) and that (n=10) with no depression was significantly different (p=0.004). Patients with anxiety (n=17) had significantly greater fatigue compared to patients without anxiety (n=13) (p=.001). The BFI and the HADS scores of patients were moderately related (r=0.571, p=0.001).

This study revealed a greater severity of fatigue in hospitalized cancer patients who had depression and anxiety. Furthermore, emotional distress and fatigue symptoms had interrelated effects. Thus, the incorporation of emotional and psychosocial elements to therapeutic interventions and successful fatigue management may be beneficial for the treatment of hospitalized cancer patients. 

Zi Huangjing TM (ZHJ) tablet, which is a mixture of echinacea and astragalus, serves as a health care supplementary for the population with sub-health status in China. This prospective, multicenter, single-arm study aimed to explore the clinical value of ZHJ for the cancer patients with CRF during the period of chemotherapy.

Patients with a score ≥4 according to the Piper Fatigue Scale (PFS) who had received chemotherapy were enrolled. All eligible patients were administered ZHJ at a dose of 2.1g twice a day throughout the period of two chemotherapy cycles. PFS, EORTC QLQ-C30 and immune function were evaluated at baseline, day 21 and day 42. The primary endpoint was the change in the total score of PFS. The secondary endpoints included quality of life (QoL) and immune index.

Results 55 patients with advanced cancer were recruited between May 2020 and August 2020, 47 (85%) of them completed the study. With the treatment of ZHJ, the mean PFS reduced significantly from 5.89±1.36 to 3.21±1.67 by day 42 (P=0.000). According to the EORTC QLQ-C30, patients' general QoL, physical functioning, role functioning, emotional functioning, cognitive functioning, social functioning, fatigue, nausea and vomiting, insomnia, appetite loss, and financial difficulties were significantly improved. The immune index including hemoglobin, albumin, globulin, albumin-to-globulin ratio, CD3, and CD4 maintained stable during the study phase. Conclusions ZHJ tablet is active for the patients with CRF who are undergoing chemotherapy, the QoL can be improved synchronously.

Falls are a major concern in older patients with cancer. Research shows strength and balance training can prevent falls in older adults; however, direct evidence to inform exercise prescription in the geriatric oncology setting is lacking. This study seeks to determine the feasibility of a 3month, virtually delivered resistance and balance training program and its effects on falls and indices of falls in this population.

The STABLE study is an observer-blinded, parallel group, randomized controlled trial (RCT). Sixty participants will be recruited using consecutive sampling. The exercise sessions will be facilitated by a certified exercise physiologist via Zoom conferencing platform. Outcome measures include feasibility, lower body strength, balance, and falls, and will be assessed at baseline(T0 ), end of intervention(T1), and 6-month follow-up(T2 ).

Intention-to-treat analysis will be performed. Descriptive statistics will be used to analyze data on feasibility, as well as muscle strength scores, balance scores, and fall rates. ANOVA with a between subjects factor and a repeated factor will be conducted. Main effects and interaction effects paired with appropriate effect sizes will be calculated.

This will be among the first known RCT to investigate the feasibility and efficacy of a virtually delivered exercise program on falls in older patients with cancer. If found feasible and effective, findings from this study can inform a subsequent, larger scale trial to inform design of definitive phase III trial.

Introduction eHealth/mHealth literacy refers to the ability to locate and comprehend online health information, which is important as >90% of people living with cancer access information online to inform healthcare decisions.

Older adults with cancer are increasingly adopting ehealth, particularly with the rapid transition to virtual care amidst the pandemic. This review documents the nature and extent of literature on eHealth literacy amongst older adult with cancer and their caregivers.

We conducted a scoping review guided by Arksey and O'Malley methodology. We ran comprehensive searches of eHealth/mHealth literacy, older adults with cancer and their caregivers in MEDLINE, Scopus, CINAHL, PsycINFO, AMED and EMBASE, from 2000-2021.

Eleven articles were included, illustrating how older adults with cancer and their caregivers have low self-perceived ehealth literacy and less confidence evaluating online health information for cancer decision-making. Socioeconomic status, rapid expansion of digital applications, and broadband access were cited as prominent barriers. eHealth literacy appears to be positively correlated with caregiver's seeking a second opinion, awareness of treatment options, shared decision making, and trust in the health care system.

Older adults are the fastest growing population with cancer. With the growing reliance on ehealth tools, developing credible digital health applications that require minimum internet navigation skills, patient education, and collaborative efforts to address access and affordability are warranted.

The main purpose of this study was to evaluate the radiotherapy (RT) toxicity patterns in older Lung Cancer (LC) patients (aged 65 or over) treated with curative intent.

This retrospective study was based on RT Department electronic health records and was approved by the institutional ethical review board. All older patients with LC (SCLC=19 and NSCLC=107) treated with curative RT between January 2013 and December 2017 were included. Patient, tumour, treatment, acute, and late toxicity data was collected.

The median age was 72 years. Performance status (ECOG-PS) 0-1 were predominant. Median follow-up time was 18 months. The median RT BED (α/β=10) was 72 Gy (56-180Gy). Chemotherapy (CHT) was performed in 31.7% (n=40). Acute and late toxicity data is illustrated on Fig.  1 , 2, and 3. Patients who performed CHT had significantly higher rates of anorexia (p=0.009), skin RTOG 1-2 (p<0.001) and pharynx&esophagus RTOG 1-3 (p<0.001). Late toxicity sub-group analysis showed that patients undergoing CHT have significantly higher rates of lung fibrosis (p=0.038) and it is more frequent in higher RT doses.

In this study, patients who performed CHT had a higher rate of anorexia and higher grade of skin and pharynx & esophagus toxicities. They also had higher rates of lung fibrosis and for them the RT dose tend to be higher and may contribute synergistically to the lung toxicity. Joseph Medical Center staff adapted this concept to oncology and permitted its use elsewhere. This quality improvement (QI) initiative examines feasibility and acceptability of this symptom management zone tool with older adults in a community oncology office.

The organization's institutional review board approved this QI initiative. The Ottawa Model of Research Use guided the team's progress. Nurses distributed the zone tool as patients started treatment and assessed comprehension using teach-back. After implementation, patients and staff were surveyed.

Thirty-one patients received the zone tool. All nurses and 36% of patients completed the survey. Nurses found the zone tool easy to use and explain to patients, and they were satisfied with the tool and its usefulness with telephone triage. Seventy percent of patients surveyed found the zone tool easy to use and had used it at least once to manage symptoms at home. All patients would recommend it to others.

Results of this QI initiative suggest that utilizing a home symptom management zone tool with a population of older adults on cancer treatment is acceptable to patients and staff and feasible in a community oncology practice. 

To complete the previous systematic reviews, and answer the following questions in older adults with current cancer and cancer survivors: (1) Are there efficient interventions to reduce their fall incidence? (2) Are there efficient interventions to improve balance or functional mobility in this population? Methods Medline, Pubmed, Web of Science and Embase were searched for this systematic review. Eligible studies included clinical trials, cross-sectional, cohort, case-control, and qualitative studies in which the entire sample or a sub-group were aged 65 years or above and had cancer, published in French or English, and in which falls were examined as a primary or secondary outcome.

After removing duplicate studies, among 762 analyzed references, 50 were assessed for full-text eligibility, but only 15 met our inclusion criteria. The heterogeneity in evaluation criteria and study populations did not allow us to compile the results for a meta-analysis.

Several interventional studies to prevent falls have been explored in oncology not specifically in older patients, sometimes positive in monocentric studies with inpatients, negative if only based on an individual physical activity program in outpatients setting. Interventions to improve balance or physical performance are efficient in cancer survivors, less data are available for patients with current cancer. Further interventional randomized studies are required. We included randomized and non-randomized controlled trials, reviews and meta-analysis, retrospective and prospective cohort studies, qualitative studies and guidelines, published between January 2013 and December 2018 that involved depression with cancer in which the entire sample or a sub-group aged 65 and above. Efficacy and tolerance of depression treatment were examined, as a primary or secondary outcome, among articles published in French or English.

Of 3171 references, only seven studies met our eligibility criteria. This systematic review reveals a lack of evidence-based knowledge in this field, preventing from making any recommendations on drug and non-drug therapies. It has highlighted the need for multidisciplinary collaboration with the French and Francophone Society of Psycho-Oncology.

In clinical practice, we advise health professionals to use the screening process not as a result but rather as an opportunity to engage with the patient, and also to question the need for antidepressants and non-drug therapies. Introduction Though the response rates to chemotherapy are similar in younger and older patients, the older age group has more deaths due to co morbid illnesses. In elderly patients with advanced cancers providing symptom relief, maintaining Quality of life (QoL), and improving physical performance remains the primary treatment goal.

Rasayana is a branch of Ayurveda which has shown potential to improve therapeutic outcomes in cancer patients. Present study evaluated the outcomes of Rasayana in elderly cancer patients with advanced cancers.

Data pertaining to QoL (FACT-G), ECOG performance status, tumor response ( Figure 1 ) and patient's survival was retrospectively analyzed using chart review in histologically diagnosed cancer patients ≥ 65 years (N=64) (Table1) treated with Rasayana therapy( Rasayana therapy can be considered as an alternative therapy in elderly cancer patients who are either ineligible for standard anticancer treatment or in those who are no longer responding to cytotoxic therapies."

The EORTC QLQ-ELD14 is a questionnaire for older patients with cancer that focus on particular problems of the elderly. This study evaluates the psychometric properties of the Portuguese version of EORTC QLQ-ELD14 in a Portuguese elderly population.

The study included 137 patients with ≥70 years and solid malignancies followed in a single center in Portugal. The authors performed the reliability (internal consistency, test-retest), validity (convergent validity comparing the EORTC QLQ-ELD14 with the EORTC QLQ-C30 and known-group comparisons), and structural validity by exploratory factor analysis (EFA).

The Cronbach's alpha coefficient was between 0.593 and 0.858. The testretest reliability analysis was acceptable in five subscales. A convergent validity demonstrated high and moderate correlations between the EORTC QLQ-ELD14 and QLQ-C30, especially in the subscales "mobility", "joint stiffness

The aim of this descriptive study was to determine oncology nurses' attitudes regarding ageism. Methods Data were collected online using a form prepared based on the literature, which includes the socio-demographic and clinical characteristics of the nurses, and the Ageism Attitude Scale. The form was applied to 237 oncology nurses between June-Semptember 2020. Data were analyzed using mean, standard deviation, median (min-max), number (percentage), independent samples t test, one-way analysis of variance (ANOVA) and Pearson correlation analysis.

It was determined that the oncology nurses' mean total score in the Ageism Attitude Scale was 87.76 ± 9.22, with scores ranging from 63 to 11. The total score for the restricting life of the elderly subscale was 37.45 ± 4.69, for the positive ageism subscale, 30.05 ± 5.27, and for the negative ageism subscale, 20.30 ± 4.58. Age, duration of work, living with the elderly, and economic status were important factors in accounting for differences among nurses in the mean scores of Ageism Attitude Scale. (p<0.05).

It was found in the study that nurses have generally positive attitudes regarding ageism. There are suggestions in the study for improving/ accounting for?? nurses' attitudes regarding ageism. Background Accelerometry research suggests physical activity may be associated with treatment toxicity, but generalizability to geriatric oncology is unclear. As many older adults have low levels of physical activity and technology use, this study fills a major research gap. The feasibility of daily step count monitoring and the association between step counts and symptoms were evaluated prospectively.

Men aged 65+ starting treatment (chemotherapy, enzalutamide/ abiraterone, or Radium-223) for metastatic prostate cancer were enrolled into a prospective cohort study. Participants reported step counts (measured via smartphone) and symptoms (Edmonton Symptom Assessment Scale) daily for~1 month. Feasibility of daily monitoring was assessed with descriptive statistics. The association between a 15% decline in steps (compared to previous day) and the emergence of moderate-to-severe symptoms (rated 4+) in the next 24 hours was tested with chi-square.

Out of 32 participants, 20 engaged in step count monitoring (mean age 74y; 63% participation; 98% adherence). Overall, 32% of 326 reported step counts reflected a 15% decline, and 55% of questionnaires contained at least one symptom rated 4+. There was no association between a 15% decline in steps and the emergence of symptoms (p=0.669). Sensitivity (34%) and specificity (69%) of step counts were low.

Despite recent studies framing physical activity changes as predictive of toxicity, we found no association. However, daily activity monitoring in older cancer patients appears feasible and may have other uses.

Malnutrition and weight loss are common complications seen in the elderly, advanced cancer population. Appetite stimulants are potential therapies for oncology patients with weight loss, yet their safety risk remains unknown.

This was a multi-center, retrospective, study conducted in New York City from January 2016 to July 2019 in adult patients with histologic evidence of malignancy who were taking either megestrol acetate or mirtazapine as an appetite-stimulating medication. Endpoints included evaluation of safety adverse events. A full-matching propensity score analysis was performed using logistic regression modeling to assess two comparable groups.

There were a total of 350 patients included in this study (69.56 ± 13.31 years). Safety adverse events were common in the elderly population. After a propensity score-matched analysis, all safety outcomes associated with mirtazapine compared to megestrol acetate were similar; thromboembolism (11%, n=11 vs. 11%, n=11, p=1.00), QTc prolongation (31%, n=31 vs. 31%, n=31, p=1.00), somnolence (29%, n=30 vs. 22%, n=23, p=0.34), xerostomia(27%, n=28 vs. 18%, n=19, p=0.24), hallucinations (17%, n=18 vs. 8%, n=8, p=0.06), and allcause mortality (7%, n=7 vs. 12%, n=12, p=0.23), respectfully.

Both megestrol acetate and mirtazapine are commonly used appetite stimulating agents in the elderly oncology population. There were no safety differences revealed when evaluating both of these agents.

Older adult survivors of cancer are considered doubly vulnerable to the deleterious impacts of the COVID-19 virus due to their compromised immunity and increased likelihood of comorbidities. The first year of cancer survivorship is critical given the adjustment to life after cancer. We sought to understand how older adults transitioning to survivorship were coping throughout the course of the COVID-19 pandemic.

We conducted a longitudinal mixed methods study (QUAL+quan) interviewing older adult survivors of cancer (n=30) at three time points during the pandemic: during wave one (Summer 2020), wave two (January 2021), and prior to vaccination (March 2021).

Older adults with cancer reported numerous strengths and capacities early in the pandemic and willingness (though not preference) to engage in virtual consultations. During latter phases of the pandemic participants struggled with ongoing virtual consultations and restrictive visitor policies as they continued to cope with nagging symptoms, potential or actual recurrence, and restrictions to social networks. Older adults described the loss of socialization activities as having isolating effects with overall implications for their wellbeing.

Older adult survivors of cancer face challenges related to persisting side effects, aging, and isolation that are compounded by the pandemic. Urgent attention is needed to tailor interventions to address the needs of this population and consider how their wellbeing can be supported during early survivorship in a pandemic and beyond.

Ageism towards older adults with cancer may impact treatment decisions, health, and psychosocial outcomes. The purpose of this review is twofold:

(1) to determine the nature and extent of literature on ageism towards older adults in cancer care; and (2) to identify interventions that address ageism in the healthcare context.

We conducted a scoping review following the Arksey and O'Malley method and PRISMA guidelines. With support from a librarian, we conducted a multi-database search and screened 30,926 titles and abstracts.

We included and abstracted data on 164 papers in this review. Most (n=60) were expert opinions highlighting the negative impacts of ageism. Although qualitative studies identified the impact of age on treatment recommendations, quantitative studies were inconclusive as to whether age-related bias impacted treatment outcomes, treatment offerings, and survival. Intervention studies (n=45) targeted ageism in pre/post-licensure health care workers/professionals and reported participants' improvement in knowledge and/or attitudes towards older adults.

Although ageism remains a concern in oncology, quantifiable evidence about its nature and impact remains elusive. Interventions exist to address ageism; however, few have been adopted in oncology. Addressing ageism in oncology will require integration of geriatric knowledge and interventions to address widespread ageist attitudes impacting care and outcomes. Interventions hold promise if tailored for cancer care settings.

Globally, cancer is a leading cause of death and impacts older adults more than any other age group. Self-management is defined as how patients with chronic conditions address and cope with symptoms, treatments, and lifestyle adjustments. Many self-management interventions are moving to an online format. Our objective was to investigate and describe how older adults engage technology for cancer self-management, particularly as they live with multimorbidity.

We used a qualitative descriptive approach and semi-structured interviews with older adults with cancer who had at least one other chronic condition. Data were analyzed using descriptive thematic analysis.

We found that older adults are interested in, if not already, engaging with technology and internet searching to manage their cancer diagnosis and treatment. Data were grouped into two themes: 1) Surfing for answers to take control, and 2) Confidence in technology supports competence in self-management. Participants felt they might need extra support learning how to craft a search, filter facts, and digest information from the internet to manage their cancer.

Older adults are interested in engaging technology to support self-management. Developing an understanding of what older adults desire from technology to support their cancer and multimorbidities could improve their confidence and wellbeing.

Introduction Care for older adults with cancer became more challenging during the pandemic, particularly in urban hotspots. This study examined the potential differences in healthcare providers' provision of and concerns about cancer care for older adults with cancer between urban and suburban/rural settings.

Members of the Advocacy Committee of the Cancer and Aging Research Group, with the Association of Community Cancer Centers, surveyed multidisciplinary healthcare providers responsible for the direct care of patients with cancer. Descriptive statistics and chi-square tests were used.

Complete data was available from 271 respondents (urban (n=144), suburban/rural (n=127)). Most respondents were social workers (42, 44%) or medical doctors/advanced practice providers (34, 13%) in urban and suburban/rural settings, respectively. Twenty-four percent and 32.4% of urban-based providers reported "strongly considering" treatment delays among adults aged 76-85 and >85, respectively, compared to 13% and 15.4% of suburban/rural providers (ps=0.048, 0.013). More urban-based providers reported they were inclined to prioritize treatment for younger adults than older adults (10.4% vs. 3.1%, p=0.04) than suburban/rural providers during the pandemic. The top five concerns reported were similar between the groups, related to patient safety, treatment delays, personal safety, and provider mental health.

These findings demonstrate location-based differences in providers' attitudes regarding care provision for older adults with cancer during the COVID-19 pandemic.

Australia has increasing numbers of older people with cancer due to the aging population, particularly in regional areas. Our project outlines application of nursing goals developed during the Geriatric Oncology: Educating Nurses to Improve Quality Care (Funded by the National Institute of Health Grant #R25CA183723-01A1) program attended in the USA.

Three SMART goals were identified: 1) using a patient-completed geriatric screening tool to identify needs; 2) linking specialist and generalist external providers via telehealth into the two-weekly supportive care multidisciplinary meetings (SCMDM) to discuss and plan care; and 3) providing national access to geriatric-oncology nurse education.

In 18-19, 92 patients were discussed at 21 0.5hr meetings. A large dataset provides unique insight into functional status, nutrition, medications, comorbidities, social support, cognition and psychological health. Regional nurses dial into the SCMDM by telehealth. Their unique understanding of discussed patients contributes to care recommendations and referrals. Data review, patient experience and health professional survey feedback drives quality improvements. A national one-day symposium had representation from all Australian states and New Zealand. Symposium evaluation informs future education. Conclusions Support and mentoring from the R25 group improved our commitment to this now embedded process. Despite some system differences, health professionals' commitment to improving care for older people with cancer is shared internationally.

Older adults with metastatic cancer experience high symptom burden associated with treatment. Regular symptom monitoring can help clinicians understand temporal patterns and durations of symptoms and design programs to provide the best supportive care. Our study's purpose was to explore common severe symptoms and their day-to-day variations in older men with mCRPC.

Men aged 65+ with mCRPC starting chemotherapy, androgen receptor-axis-targeted (ARAT) therapies, or radium-223 (Ra223) from Princess Margaret Cancer Centre were enrolled in a prospective cohort study. Participants self-reported symptoms daily using the Edmonton Symptom Assessment Scale (ESAS) for 3-4 weeks. Descriptive statistics were used to assess feasibility, symptom severity, and symptom duration. Results 481 ESAS questionnaires were completed (87-94% adherence) by 10, 13, and 6 older men (75 +/-6 years old) starting chemo, ARAT, and Ra223. Baseline characteristics are shown in Table 1 . Most common severe symptoms (>7) reported by patients in each cohort are shown in Figure 1 . Decreased appetite, poor wellbeing, and insomnia were reported more frequently than in the registration trials. Severe symptoms lasted 2.0, 0.9, and 2.2 days on average in patients undergoing chemo, ARAT, and Ra223.

Daily symptom monitoring is feasible among older mCRPC patients. The most common severe symptoms were fatigue, decreased appetite, and poor wellbeing, but most last 1-2 days. Adjusting frequency of monitoring may result in improved symptom outcomes in elders receiving mCRPC treatments.

D. Pon 1 , P. Hsieh 2 , J. Salman 3

Some studies indicate that cancer patients may have a higher risk for falls than non-cancer patients. Few studies have evaluated fall risks in autologous hematopoietic stem cell transplant (autoHSCT) patients.

We conducted a retrospective, institutional review board-approved, casecontrol study of adult patients admitted for autoHSCT between 2014-2019. Patients who fell (fallers) were identified from the institutional reporting system and matched in a 1:2 ratio to non-fallers based on age, gender, cancer diagnosis, and admission date. Patient demographics, clinical characteristics, medications administered within 24 hours, and fall events were recorded. Logistic regression was used for data analysis. Primary outcome was fall-related risk factors. Secondary outcome was fall-related complications.

Results 72 patients experienced falls and were matched to 144 non-fallers. Mean age of fallers was 57.5 years. History of depression, anxiety, gait instability, altered mental status, incontinence, and use of benzodiazepines, antidepressants, or antipsychotics were associated with increased fall risk in univariable analysis. In the multivariable model, administration of benzodiazepines (OR=5.0, 95% CI=2.2-11.1), antidepressants (OR=2.6, 95% CI=1. 2-5.8) , and antipsychotics (OR=29.6, 95% CI=2.9-301) remained statistically significant fall risks. Some level of injury was experienced by 41% of fallers.

In autoHSCT patients, use of benzodiazepines, antidepressants and antipsychotics were associated with an increased risk for falls. 

While there are guidelines for GA and intervention based on GA for inperson GAs, there are no guidelines available what tools and intervention recommendations to include in an online GA. While several online geriatric assessments exist, patients do not receive feedback from the tools. The aim for our tool is to have it provide recommendations to both the oncology team and the patient. We used a modified Delphi approach to develop a consensus online GA tool.

A review of all available GA and intervention guidelines for each GA domain were retrieved and reviewed. Statements for the panel were developed including those tools and interventions. Panel members were invited by email to complete the consent form and complete a short survey to describe the panel and 85 statements organized by GA domain and included statement about proposed assessment tools and interventions in case the assessment indicated impairment. Each item was rated on a 7-point Likert scale for feasibility for inclusion in the tool and importance. Consensus is defined as >70% of the panel scoring ≥ 6 on importance AND feasibility.

Thirty-four Canadian clinical experts in geriatrics, oncology, and oncology nursing were invited to participate and 32 agreed (see Table 1 ). The first round was completed Dec 31 2020 and based on the results and feedback the 85 statements were reduced to 51. Round 2 is ongoing for the panel members. We will present the final document at the conference.

This study will present a consensus document for the development of an online GA tool. 

To identify what self-management interventions can be used by older adults to address issues identified in a geriatric assessment and to determine their effect on patient-centered outcomes such as patient knowledge and empowerment.

Searches were conducted on September 6, 2019 by a health sciences librarian in Medline, Embase, CINAHL, PsycInfo, and the Cochrane Library. A combination of database-specific subject headings and text word searches were used including self-care, self-management, a key word for each of the geriatric assessment domains , older adults, and aged. Two independent reviewers reviewed abstracts and full texts for inclusion and abstracted data. Narrative synthesis was used to summarize findings.

Among 17,789 abstracts reviewed, 32 studies were included. The most frequently reported outcomes were mobility/falls (n=12), quality of life (n=9), mood (n=8), and functional status (n=5). The majority of studies demonstrated positive effects on mobility/falls (9 of 12), pain (3 of 4), social support (3 of 4), comorbidity (3 of 3), and medication management (2 of 2). Most studies were of moderate quality.

A variety of effective self-efficacy-targeted interventions exist for older adults to improve several important geriatric domains and related outcomes.

T. Tsuji 1 , N. Tatematsu 2 , J. Ueno 3 , Y.Koishihara 3 , N. Konishi 3 , H. Fujiwara 3 , T. Fujita 3 , T. Harada 4

Recently, skeletal muscle mass change after esophagectomy has been reported to impact on not only quality of life, but also survival rate. The aim of this exploratory retrospective study was to investigate predictors of skeletal muscle mass change after esophagectomy.

The participants were 54 patients who had undergone esophagectomy from 2015 to 2018 and inpatient rehabilitation. The Skeletal Muscle Mass Index (SMI) was calculated from preoperative and postoperative CT images as follows: total skeletal muscle area at the level of the third lumbar vertebra/height (cm2/m2). The primary outcome was the SMI change ratio [(postoperative SMI-preoperative SMI)/preoperative SMI × 100 (%)]. Potential predictors of the SMI change ratio were analyzed with multiple regression analysis.

The mean SMI change ratio 4 months after esophagectomy was -7.1 ±9.4%. Neoadjuvant chemotherapy (standardized β=.387, p=.008) and the change ratio of knee extension strength for a month after surgery [(postoperative strength-preoperative strength)/preoperative strength × 100 (%)] (standardized β=.274, p=.038) were predictors of the SMI change ratio independent of sex, pathological stage, age, and preoperative SMI.

Neoadjuvant chemotherapy and short-term muscle weakness of the lower extremity after esophagectomy were predictors of the SMI change ratio after esophagectomy. Continuous comprehensive rehabilitation for physical activity and nutrition may inhibit loss of skeletal muscle mass by improving muscle strength. In Japan, Long-term Care Insurance (LTCI) Law was implemented in 2000 and the insurance system was established to support the independence of the elderly by the entire society. It is a system that comprehensively evaluates their physical, mental, and social activities, i.e. geriatric assessment (GA) itself. However, this system has not been incorporated into cancer treatment. This system and cancer treatment has not worked in close cooperation with each other. We conducted a questionnaire survey to find the reasons why GA as well as cooperation of nursing and medical care is not implemented. Under the grant support by the Ministry of Health, Labour and Welfare on "Research on the infrastructure necessary to develop guidelines for cancer treatment of the elderly," The questionnaires were sent to 795 hospitals, and 631 departments in 340 hospitals responded to the survey. 81.5% did not perform GA. The common reasons for not conducting GA were lack of knowing GA (54.0%) and lack of personnel (35.5%). Even if GA was conducted, 63.6% did not utilize the results in clinical practice. 61.7% of the respondents were familiar with the LTCI as were 62.9% its certification process. 28% used LTCI assessment to some degree for treatment planning. The GA is less recognized than the LTCI, and its results are also rarely used in clinical practice. On the other hand, the results of LTCI certification were used in 28% for decision making on management. This survey found for the first time the incorporation of LTCI system into medical care in treating the vulnerable elderly cancer patients.

Oral Proffered Paper SAFETY PROFILES OF ANTICOAGULANTS USING THE EMA PHARMACOVIGILANCE DATABASE N. Janus 1 , I. Elalamy 2 , N. Janus 3

Low molecular weight heparin (LMWH) has been the standard of care for cancer-associated-thrombosis (CAT). But recent data reported the use of direct oral anticoagulant (DOAC) in CAT patients with a higher rate of bleeding and with a higher rate of gastrointestinal (GI) bleeding.

The european database of suspected adverse reaction were checked for reports concerning DOAC&LMWH. Patients with an anticancer drug was considered as cancer patients. Data regarding the GI bleeding were analyzed.

Results 216540 cases were found. Most patients were >65 years (63.8%). 32591 cases for a LMWH and 183949 for a DOAC. 2080 received an anticancer drug and 79783 did not. Co-mediation data were missing for all other cases. GI bleeding was common in both cancer (10.3%) and non-cancer patients (16.0%) ( Table 1) .

Conclusions GI bleeding were common in both cancer and non-cancer patients.

Although the LMWH population was smaller than the DOAC population, these data could suggest that LMWH patients were less exposed to GI bleeding in all patients with thrombosis and not only in GI cancer patients. However, it is important to consider all the limitations of the database with limited information. 

Venous thromboembolism (VTE) is a difficult to treat condition in cancer patients with a persisting risk of recurrent VTE (rVTE). We conducted a prospective multicenter observational cohort study in VTE cancer patients treated with tinzaparin for 6 months in order to validate the Ottawa score. The Ottawa score is composed of 5 items, female (+1), lung (+1), breast (-1), cancer stage 1 (-2) and previous VTE (+1).

Adult cancer patients with recent diagnosis of documented VTE treated with tinzaparin for 6 months were included. The primary endpoint was the rVTE within the first 6 months. Other endpoints were symptomatic rVTE and major bleeding (MB). All events were adjudicated by a Central Adjudication Committee. To validate the Ottawa score, the area under the curve (AUC) and its 95% CI were calculated on receiver operating characteristic curve analysis.

Results 409 patients were included; median age: 68 years; pulmonary embolism: 60.4%; lung cancer: 31.3%; digestive cancer: 18.3%; stage IV cancers: 67.0%. According to Ottawa score, 58% were classified at high clinical probability of recurrence (score ≥ 1). Among all patients, during the 6 months treatment period, 7.3% and 3.7% had rVTE and MB, respectively. 9.1% had rVTE for patients with a score ≥ 1 compared to 4.2% for other patients (score < 1). AUC of the Ottawa score was 0.60 (95% CI 0.55-0.65).

This prospective cohort of patients with cancer receiving tinzaparin for VTE reported that the Ottawa score did not accurately predict rVTE. Methods ACT4CAT a prospective observational study conducted by HeSMO, aiming to record clinical practice of prophylaxis in pts with solid tumors. Ambulatory, ca pts receiving thromboprophylaxis enrolled after signing informed consent.

Oncology departments (18) 

Pancreatic Cancer (PC) stands up with a Venous Thromboembolism (VTE) risk 4-7-fold higher than other malignancies. Primary Thromboprophylaxis (PTP) reduces VTE burden but remains largely underused. The study characterizes the incidence of VTE in PC treated patients and analyses the PTP efficacy and its impact in Overall Survival (OS) and Progression-Free Survival (PFS 

Kinase inhibitors (KI) and antibodies targeting the VEGF pathway are approved in a broad spectrum of cancers, and associated with an increased risk of bleeding and thromboembolic events (TE). The use of DOAC apixaban and rivaroxaban is increasing in cancer pts, but limited data are available for patients receiving anti-VEGF agents.

We retrieved medical records of all pts receiving concomitantly DOAC and anti-VEGF agents from 2013 to 2020 in our center.

Of 92 pts (median age 62 years (31-82)), 40 were treated with KI and 52 with bevacizumab. The most frequent primary tumor sites were colon/ rectum (34%), kidney (20%), ovary (13%), thyroid (11%) and lung (11%); 3% had brain metastases. Apixaban 5 mg bid (n=60) or rivaroxaban 20 mg daily (n=32) were given for TE (63%), atrial fibrillation (28%) or other indications (9%). The median duration of concomitant treatment was 4.8 months (0.7-50.0) with bevacizumab and 11.7 months (0.1-53.8) with KI. Grade ≥3 bleeding events occurred in 5 pts: 4 pts receiving bevacizumab (one grade 5 upper digestive tract bleeding and three grade 3 rectal or vaginal hemorrhages) and 1 patient under cabozantinib for kidney cancer with endobronchial metastasis (grade 3 hemoptysis). Grade ≥3 TE occurred in 8 pts: 7 pts receiving bevacizumab (including one grade 5 pulmonary embolism), and one pt receiving sunitinib (grade 3 pulmonary embolism).

In our experience, the use of DOAC was safe in selected pts treated with KI, but unclear with bevacizumab. More data are needed to endorse guidelines in this specific group of pts. 

Gastro-intestinal (GI) issues such as gastric/duodenal ulcer, gastritis, stomatitis, colitis, esophagitis are still common in cancer patients. Cancer-associated-thrombosis (CAT) patients were also reported to be exposed to such GI disorders/toxicities and several publications recommended to consider these GI disorders/toxicities when choosing an anticoagulant in CAT. However, little is known about the nature of the anticancer drugs that CAT patients are receiving. The aim of this work was to check all the anti-cancer's SmPCs (Summary of Product Characteristics) for GI issues.

All SmPCs of anticancer drugs indicated for lung cancer were checked on the EMA website. All adverse events regarding GI disorders/toxicities were collected. The frequency of adverse events experienced were the following: very common (≥ 1/10) and common (≥ 1/100 to < 1/10).

Twenty-eight anticancer drugs were identified with a mix of traditional chemotherapies, tyrosine kinase inhibitors and monoclonal antibodies. Among these 28 anticancer drugs, 26 had at least one very common/ common GI disorders/toxicities. Vomiting (82.1%) and diarrhoea (89.3%), stomatitis (71.4%) and colitis (10.7%) were very common or common among these anticancer drugs.

Conclusions GI issues are common in anticancer drug's SmPCs. Consequently, it is important to be aware of this before choosing an oral anticoagulant treatment or an injectable one. Clinical data are still missing, it is reasonable to check for GI issues risks in order to initiate an adequate anticoagulant treatment in CAT patients. 

Hemostatic RT is an effective approach to tumor-related gastric bleeding. Improvement in hemoglobin levels, besides improving quality of life and decreasing the need for further transfusions, can restore patient's conditions to continue antineoplastic treatments.

A. Bui 1 , J. Said 2 , S. Singer 3 , J.Hirner 2 , A. Cunningham-Bussel 4 , C. Larocca 2 , J. Merola 2 , C. Lian 5 , N. LeBoeuf 2

With the success of immune checkpoint inhibitors (ICI), there is an urgency to better characterize dermatologic immune-related adverse events (irAEs). In this study, we evaluated the frequency of immunotherapyassociated de novo cutaneous connective tissue disease (CTD) and reported clinical features and management. Methods A retrospective cohort study of 4,487 patients receiving pembrolizumab, nivolumab, durvalumab, atezolizumab, tremilimumab, and/or ipilimumab at Dana-Farber Cancer Institute/Mass General Brigham between December 2013 and July 2019.

Among this cohort, 11 patients had immunotherapy-associated cutaneous CTD, for a frequency of 0.025%. Six (54.5%) were men. Median age was 59 years (53-69). Median time to onset was 8 months (0.5-26). There were 8 cases of subacute cutaneous lupus erythematosus (SCLE) (72.7%), 1 of systemic lupus erythematosus (SLE) (9.1%), 1 of eosinophilic fasciitis (9.1%), and 1 of dermatomyositis (9.1%). Among 9 tested, all had positive antinuclear antibodies (range, 1:80-1:5120). Among 7 with SCLE tested, 6 (85.7%) had positive anti-Ro(SSA) and 5 (71.4%) had positive anti-La(SSB) antibodies. Patients were treated with skindirected (100%) and/or systemic therapies (36.3%). ICI was discontinued in 1 patient for dermatomyositis and held in 1 patient for SCLE.

Major findings include the rarity and striking lack of heterogeneity of immunotherapy-associated cutaneous CTD. Clinicians must have a high index of suspicion to appropriately diagnose these disorders to prevent immunotherapy interruption. 

The relationship between peripheral blood count and the immunerelated adverse events (irAEs) has not been clarified in patients with advanced non-small cell lung cancer (NSCLC) treated with nivolumab. Thus, this study aimed to identify peripheral blood count that may be predictive of the development of nivolumabinduced irAEs.

This multicenter observational study retrospectively evaluated consecutive patients with advanced NSCLC who received nivolumab in the second-or later-line setting between December 2015 and November 2018 at the National Cancer Center Hospital and Keio University Hospital. The primary endpoint was the association between peripheral blood count and irAEs during the 6-week study period.

A total of 171 patients evaluated, 73 (42.7%) had ≥1 irAE during the first 6 weeks after treatment initiation. Receiver operating characteristic curve analyses revealed that the optimal cutoff values of the absolute lymphocyte count (ALC), neutrophil-to-lymphocyte ratio, and lymphocyte-tomonocyte ratio at 2 weeks after treatment initiation for the early onset of irAEs were 820, 4.3, and 2.2, respectively. In multivariable logistic regression analyses, an ALC of >820 at 2 weeks after treatment initiation was significantly associated with an increased risk for the early onset of any irAE. In contrast, no significant association was observed for other peripheral blood count.

Considering routinely available ALC after the initiation of nivolumab may be useful for identifying patients at risk of the early onset of irAEs.

Oral Proffered Paper ORAL MICROBIOME PROFILES OF HAEMATOPOIETIC STEM CELL TRANSPLANT PATIENTS WHO DEVELOP GRAFT-VERSUS-HOST-DISEASE

Graft-versus-host disease (GVHD) is a complication of allogeneic hematopoietic stem cell transplant (HSCT) resulting from an immune reaction by donor cells against the recipient. The role of oral microbiome (OM) in GVHD development is not well understood. Our objective was to identify pre-HSCT microbiome profiles of patients who underwent total body irradiation (TBI) prior to HSCT.

Oral samples (stimulated saliva, and swabs of buccal mucosa, superficial supragingival plaque, and tongue) were collected pre-TBI (baseline [BL]) and post-TBI pre-transplant (Day 0 [D0]). Bacterial DNA was isolated and 16S-rRNA gene next generation sequencing was used to determine the relative abundance (RA) of >700 oral bacterial species. Patient groups were: GVHD positive (GVHD+; N=4) and GVHD negative (GVHD-; N=9). PERMANOVA and LEfSe were used for cross-sectional analyses. Chi-squared test was used to compare RAs of GVHD+ vs. GVHD-for LEfSe-identified probes.

Significant differences were found between samples of GVHD+ (BL, n=13; D0, n=8) and GVHD-(BL, n=28; D0, n=20) groups, using BL or combined BL&D0 data (p<0.05). LEfSe analysis identified >100 significant probes. In combined BL&D0 analysis, G V H D -g r o u p w a s c h a r a c t e r i z e d b y h i g h e r R A f o r Capnocytophaga spp. (p<0.05), possibly impacting TLR4mediated host-response. GVHD+ group had higher RA for Haemophilus parainfluenzae (p<0.05).

Pre-transplant microbiome profiles differ between GVHD+ and GVHD-HSCT patients. Our findings await confirmation using a larger patient cohort. , and 4 osteonecrosis of the jaw (MRONJ) were observed. Immunotherapy was discontinued due to immune-related pneumonitis and thrombosis (n=3) and disease progression (n=8). MRONJ, all involving the mandible, were managed conservatively; 3 patients discontinued BTA. One patient died of immune-related hepatitis and 4 of cancer.

Immune-related lesions were most common; however, oral infections and MRONJ were also observed. Interplay between immunotherapy and cancer therapy including prior, often sequential regimens, and/or concurrent with immunotherapy, might be related to the different oral complications. Comprehensive management by oral specialist will maintain patient wellbeing during immunotherapy. ABs-1330

Malnutrition is one of the major risk factor that affects the patient health status and quality of in patient with cancer. H&N cancer are more vulnerable group and more prone to nutrient deficiencies and poor immunity. Malnutrition and immune suppression make patients highly susceptible to postoperative infections and complications¹. 

Metastatic melanoma (MM) trials suggest similar outcomes and toxicity profiles of checkpoint inhibitors (CIs) as first-line therapy (1LT) or second (2LT). Real-life data is limited. We aim to describe toxicities and time to event (TTE) for CIs used as 1LT or 2LT in MM.

Retrospective single center analysis of MM patients treated from 2014-2019 with CIs as 1LT or 2LT. We defined TTE as time from the beginning of CIs to disease progression, death or discontinuation of treatment from grade (G) 3-4 adverse event (AE). Analysis at 6 months (m) was performed.

In total 39 patients with MM received CIs, 24 as 1LT and 15 as 2LT ( 

Data from this real-life MM CIs-naïve cohort showed no differences in TTE at 6m and toxicities between CIs in 1LT or 2LT.

A common and severe adverse effect experienced by colorectal cancer patients is chemotherapy-Induced Peripheral Neuropaty (CIPN). CIPN is associated with sensory symptoms including numbness and tingling of hands and feet, pain, and aberrant temperature sensation, and may persist after discontinuation of chemotherapy. Chemotherapy-related cognitive impairment, known as Chemobrain, is a frequent consequence of cancer treatments associated with short-and long-term mood alterations and cognitive deficits. Mushroom extracts contain Ergothioneine whose blood levels have been related with lower prevalence of CIPN. In the present work the potential of ergothioneine-rich mushroom extracts to mitigate both CIPN and Chemobrain was studied.

Three clinical cases with colorectal cancer patients receiving oxaliplatin were monitored as patients consumed standardized mushroom extracts. All three patients took mushroom extracts from the start of the chemotherapy up to one month after the end of the treatment.

Based on this clinical experience, it was observed that patients taking mushroom extracts during their chemotherapy treatments, both in taxane and oxaliplatin-based regimens, did not develop peripheral neuropathy or only in grade I (mild tickling in palms and soles lasting the first 24 hours after the infusion). Mood improvements were also experienced by those patients.

Due to these encouraging results, a first clinical trial will start in 2020 with colorectal cancer patients in a major university hospital in Spain. Our study shows that EPSILoN score is a very impactful predictor model of survival in patients with aNSCLC.

The incidence of Infusion reactions (IRs) in clinical trials using Daratumumab have led to the recommended administration rates, which result in infusion times for the first, second, and subsequent infusions of 6.5,4, and 3.25 hours, respectively. Previous experience with the infusion of monoclonal antibodies supports the hypothesis that infusion of daratumumab in less time than that indicated in the technical sheet would not increase the number of Irs.

Retrospective observational study of patients treated with Daratumumab from December 2017 to December 2019.

Eleven patients received treatment with Daratumumab (4 males, 7 females, mean age: 68.9 years). Only four patients followed the recommended rates of infusion included in the data sheet (starting at 50 mL/h to a maximum of 200 mL/h). In the first infusion, two patients presented intense cough and dyspnoea requiring hospitalization. Our protocol established initial infusion rate of 200 mL/h (over 30 min) and, if there were no Irs, increase up to 400 mL/h (total infusion time, 90 min) in those patients who did not present Irs in the first 3 doses of daratumumab. This protocol was carried out in 7 patients and none reported Irs.

Daratumumab is well tolerated in most patients and it is therefore considered a safe treatment. The 400 mL/h rate resulted in a decrease of approximately two hours in the patient's stay at hospital. Further prospective safety studies in clinical practice are required to confirm these preliminary data. Introduction A large body of research supports the benefits of medicinal mushrooms in cancer patients, including randomized, double blind placebo control studies and meta analyses. Quality of life of breast cancer patients undergoing chemotherapy, radiotherapy, surgery and hormone therapy can be increased by oral supplementation with standardized mushroom extracts containing biologically active compounds. Those contribute to mitigate lymphocyte depletion and fatigue and to ameliorate immune response in those patients. In addition, chemotherapy-induced peripheral neuropathy and cognitive decline can be mitigated in colorectal cancer patients by medicinal mushrooms.

An important role for gut microbiota in quality of life, as well as, in treatment response has been recently been proposed in different studies and the potential of standardized medicinal mushroom extracts to beneficially modify gut microbiota in cancer patients is being currently monitored in different clinical cases.

Results show different trends and support the potential of medicinal mushrooms to modify gut microbiota in cancer patients in addition to other benefits in quality of life. Conclusions A randomized double blind placebo controlled trial is taking place in a spanish Hospital studying the ability of a standardized medicinal mushroom extract to modulate gut microbiota and affect quality of life in breast cancer patients. Other initiatives explained by the authors include an observational study in patients suffering hand and foot syndrome.

Prison is a challenging, austere environment in which to provide supportive care (SC). The prison population is growing in size, age and frailty whilst cancer is prevalent. Evidence to guide SC in this idiosyncratic setting is lacking.

Prison Ombudsman fatal incident reports (FIRs) concerning patients who died of cancer in prison from 2016-17 were subjected to thematic analysis and triangulated with cases from our hospital.

Results 60 FIRs and three clinical cases were analysed. Lung cancer was the leading cause of death and COPD the most prevalent co-morbidity; both were more prevalent compared to the non-incarcerated population. Two patients died directly as a result of their treatment. Three themes were identified: Individual Prisoners were clinically complex; substance abuse and multimorbidity was common and complicated SC. Mistrust of authority, or efforts to maintain a low profile reduced concordance with treatment. 

Patients enrolled in oncology phase 1 trials (ph1) are heavily pre-treated with many unmet needs. Despite a high risk of disorder, there is a lack of data on sexuality in ph1. Our prospective study aims to assess supportive care needs, quality of life (QoL) and sexuality in ph1.

Between September 2020 and June 2021, we included consecutive volunteer patients enrolled in ph1 at Gustave Roussy in France. Supportive care needs, QoL (EORTC QLQ-C30) and sexuality (FSFI for women, MSHQ for men) were assessed at baseline, one, three and five months. We also investigated the association between clinical characteristics, QoL and sexuality.

As preliminary results, 140 patients' baseline data were analyzed until 11th March 2021. Patients expressed the need for consultations in algology, nutrition, psychology and sexology in 29%, 27%, 19% and 11%, respectively. Lower global Qol was associated with higher CRP level (p<0.001), pain intensity (p<0.001), Performance Status (PS) (p<0.001) and urogenital primary tumor (p=0.004). Eighty-nine percent of women and 46% of men had sexual dysfunction. In men, a lower MSHQ score was associated with urogenital location (p<0.001), age > 60 years (p<0.001), pain intensity (p<0.001), PS (p<0.001), anti-hypertensive drugs (p=0.001) and previous pelvic intervention (p=0.002).

There are significant needs for supportive care in ph1, especially in some subgroups of patients. New models of care should be developed to improve early phase pathways. Detailed results including follow-up will be released at the congress. Introduction

To evaluate quality of life (QoL) and skin toxicity in patients with head and neck cancer (HNC) treated by combined modality therapy and longitudinally evaluated with EORTC QLQ-C30, QLQ-H&N43 and Skindex 29 questionnaire.

From February to October 2020 we enrolled 10 patients with diagnosis of HNC who underwent exclusive radiotherapy (RT) or RT+chemotherapy (Cetuximab or Cisplatin). All patients underwent IMRT with a range dose from 52.8 to 69.9 Gy and completed the questionnaire at baseline, onset of Radiation Dermatitis (RD) ≥G2 (CTCAE v5.0), and 4 and 8 weeks after the onset of RD and are monitored with skin dressings (mepilex ® transfer, hydrocolloid thin, jelonet ® gauze, biathain® adhesive, calcium alginate, cuticell ® contact).

An improvement was observed for global health status (GHS) QoL of 26% (Fig.A) . The mean value of the five scales of functioning ranged from 65 (emotional functioning) to 96.67 (cognitive functioning) (Fig.A) . Effects of skin disease evaluated with Skindex-29 were more significant for symptoms scale (Fig.B ). An advanced nursing team applied dressings for median of 6.5 days with an average cost of 27.76 EUR (€) for patient and 6.33 € day/patient with a complete regression of RD G2.

Advanced wound care was cost-effective from our preliminary analysis. The possibility to reduce skin toxicity with IMRT and topical intervention evidenced the efficacy to reduce interruption of RT and an improvement of QoL. Background Senior Residency training involves multiple non-core postings in allied specialties such as PMR, Psychiatry, Emergency medicine, Pulmonary medicine, Geriatric medicine, Neurology, and Medical Oncology. Methods A questionnaire including questions on scope of early palliative medicine, ideal site of integration, role of opioids in management of non-cancer pain, preference for interventional pain procedure, role of rehabilitation in the terminally ill patient, and barriers to integration was distributed among Physical therapy trainees and faculty.

The PMR professional did not display an awareness of the scope of Early palliative care. There was a lack of agreement on the ideal setting of integration. Majority were undecided on the necessity of presence of therapist during each home care visit. There was a lack of consensus on ways to overcome challenges towards interdisciplinary integration and role of physical medicine specialists at the end of life. There was agreement that opioids should be used for non-cancer pain upon failure of an interventional pain procedure. Most of the respondents supported the use of morphine in chronic non-cancer pain. A majority of professionals agreed that their preference in performing an interventional pain procedure would be dictated by underlying cause of pain (cancer versus noncancer).

Interdepartmental training programs involving residents along with participation in academic activities and research can be a means to achieving closer integration of patient care services. 

Ovarian cancer has a 5-year survival rate of 46%. Better survival has been shown for patients able to complete more of their planned chemotherapy. Exercise during chemotherapy may reduce side-effects improving chemotherapy tolerability. We aimed to evaluate if exercise intensity or sedentary time during chemotherapy, or changes from pre-to-post diagnosis, were associated with chemotherapy completion.

Women in the Ovarian cancer Prognosis And Lifestyle Study who received ≥3 cycles of carboplatin and paclitaxel and completed the Active Australia Survey during chemotherapy were included in this analysis (n=321). We asked about exercise and sitting time before their cancer (at baseline) and in the past week (during chemotherapy). We used logistic regression to assess associations between exercise/sitting time and chemotherapy completion (defined as relative dose intensity (RDI) ≥85%).

Just over half of the cohort (58%) received ≥85% RDI. Those exercising ≥30 minutes/week at moderate-strenuous intensity during chemotherapy were more likely to complete ≥85% RDI (OR 2.1; 95%CI=1.1-3.9). Those who maintained moderate-strenuous exercise from pre-to-post diagnosis were most likely to complete chemotherapy. Sitting time was not associated with chemotherapy completion.

Supporting women to do moderate-strenuous exercise during chemotherapy for ovarian cancer may improve chemotherapy completion and in turn overall survival.

Cancer care is becoming increasingly complex. There is a growing aging population with a greater incidence of cancer, and a deficit of oncologists, with a projected shortage of 1487 by 2025. Onco-Hospitalists are well-positioned at providing the best patientcentered care of the hospitalized cancer patient and can help accommodate the patient load.

The Department of Hospital Medicine (DHM) at MD Anderson Cancer Center (MDACC) in Houston, Texas, U.S.A., attracts a growing number of physicians ("Onco-Hospitalists") specialized in the comprehensive care of the hospitalized cancer patient, as well as in medical education, research, policy, administration, and leadership.

The increasing role of Onco-Hospitalists in cancer patient care is evident by the expansion of services provided by the DHM at MDACC since its inception in 2006, as evidenced by the rise in patient activity with a 162% growth percentage increase in patient encounters, and a 168% growth percentage increase in patient's revenue. Additionally, Onco-Hospitalists provide care to all cancer patients with COVID-19 that require hospitalization; their influence is also seen in medical education, research, and quality improvement activities.

Onco-Hospitalists focus on the comprehensive care of hospitalized cancer patients, and they provide value. Increasingly, hospitals are employing specialty onco-hospitalist teams, staffed by oncologists or internal medicine physicians with expertise in the management of complex cancer patients, and the trend shows no signs of slowing.

Introduction

The importance of building physiological and psychological resilience prior to cancer treatment (prehabilitation) is increasingly recognised; yet availability is restricted to higher-risk patients in secondary care or patchy charity provision.

Whilst waiting for treatment, our patients often ask: "how can I prepare?". A service improvement project was undertaken to meet this need with prehabilitation in primary care. The service needed to be: 1. Sustainable 2. Holistic 3. Empowering A patient activation measure (PAM) was conducted before and after a prehabilitation consultation (PC).

Results 12 patients awaiting treatment of a newly-diagnosed cancer were enrolled.

1. Each 20min PC was sustainable with 25min of clinical activity undertaken in the PC in addition to that concerning the cancer diagnosis (for example chronic disease and medication reviews) along with the use of pre-existing local charity services. 2. GPs took a holistic approach as 'expert generalists' by addressing: chronic disease optimisation, medication rationalisation, social support, vaccination, symptom-control, diet, exercise, smoking cessation and psychological therapies.

3. Patients felt more empowered to improve their health. Seven patients (58%) returned both PAMs; significant improvements in scores were seen following the PC (p<0.0001).

GPs will need to innovate to meet the increasing need for cancer care. Our time and cost-neutral PC is effective in empowering patients and could be adapted for use elsewhere in general practice.

Q. Chen 1 , X. Ding 1 , Z. Guerra 1 1 University of Texas at Austin, Steve Hicks School of Social Work, Austin, Texas, United States

Psychoeducation has been found effective in improving psychosocial outcomes of caregivers. However, little is known about psychoeducational interventions targeting family caregivers of patients with advanced cancer. This scoping review aims at identifying the outcomes and their effectiveness of psychoeducation intervention studies on advanced cancer caregivers in the literature.

Seven databases were searched to identify eligible studies published before 2020 using the criteria: 1) English language; 2) experimental design; 3) care recipients are patients with an advanced cancer diagnosis. Reference lists of systematic reviews identified in the search were also screened manually.

We identified twelve studies that met the eligibility criteria among 796 articles retrieved. Only four studies identified the race/ethnicity of the samples, and among these, the majority were white. The interventionist of the psychoeducation was dominantly nurse. Overall, eleven studies found significant increases in caregiver preparedness, rewards, competence, quality of life, self-efficacy and problem-solving skills post-intervention. In seven studies measuring mental and emotional health, 71.4% did not find statistically significant improvement. Out of three studies evaluating burden, two reported partial significant improvement.

Scarce effects on easing the burden and mental distress suggest the importance of incorporating other social support and mental health components in psychoeducation for advanced cancer caregivers. (1624) or Other (951). Baseline characteristics were generally comparable between the two grps ( Table) . Unadjusted incidence of FN was 6.4% (95% CI, 5.2%-7.6%) in the OBI grp vs 9.4% (7.5%-11.2%) in the Other grp with a 34% FN risk reduction; 1455 pts (90%) received OBI in every cycle ( Figure) . Unadjusted incidence of chemotherapy dose delays was 4.4% (3.4%-5.4%) in the OBI grp vs 6.9% (5.3%-8.6%) in the Other grp; the incidence of dose reductions was comparable in the two grps. 

Eighty-two pts were seen, 40 were female; median age was 63.9. Most pts had a primary CNS tumor (79%) and were receiving cancer directed therapy (68%). The visit led to a change in medical management in 71% of pts; to discussions of advanced care planning (ACP) in 43%, of prognosis in 35%, and of coping with cancer in 27%; and to a change in rehabilitation/physical therapy in 68%. Over half the pts (59%) had never seen a CM prior to MdCC visit, but 72% of pts had specific CM needs that were addressed during

Breast cancer treatment can result in pain, reduced range of movement (RoM) and lymphedema. Patients are discharged onto self-management (SM) pathways often with limited knowledge or resources. Novel models of care are needed to support SM and reduce cycles of referrals and disjointed care. Patient feedback/co-design was used to develop a swimming rehabilitation program. Following local hospital committee approval and funding from Macmillan, participants were invited to "Take the Plunge".

Participants attended 3 x 40 minute hydrotherapy sessions to learn targeted rehabilitation exercises, consolidated with 6 weekly private group sessions at a public pool supported by hospital staff. RoM was measured for shoulder function pre and post rehabilitation, with validated tools including QuickDASH, EQ 5D5L and EORTC QLQ30, enriched with participant and staff feedback. Results 40 participants enrolled; age 58 (37-86), 4 -165 months since diagnosis, 79% shoulder problems, 55% lymphedema, 76% pain. Physical and psychological benefits were found. All participants showed an improvement in ROM following hydrotherapy, this was sustained or improved at the public pool. QoL metrics improved; referrals to outpatient services, pain and fatigue were reduced reflected in participant feedback.

Swimming rehabilitation is a successful innovation changing both participant and provider behaviour. As a novel solution, supporting participants beyond hospital care enables breast cancer patients to embed life-long skills to allow SM in the future. 

I N T E G R A T I V E C A N C E R C A R E D U R I N G T H E O N C O L O G I C A L P E R I -O P E R A T I V E P E R I O D

Cancer patients undergoing surgery are often protein malnourished or at risk of malnutrition. The demand for branched-chain amino acids (BCAAs) supplementation in those patients is increasing. This systematic review (SR) objective is to clarify and synthesize the existing evidence base of the use of BCAAs in patients with cancer during the perioperative period.

Methods A rigorous SR with meta-analysis was conducted following an a priori protocol and registered on the PROSPERO website (CRD42018086168).

Twenty relevant articles were included, comprising 13 RCTs and 6 observational cohort studies (in 7 reports). More than 2000 participants in total were included. The majority of RCTs (77%) dealt with liver cancer. BCAAs were administered orally in 69% of RCTs, while 31% administered them intravenously. Methodological study quality assessment suggested a substantial risk-of-bias across most RCTs. Meta-analyses of the RCTs found statistically significant 38% decreased risk of post-operative infections (p=0.006), 45% reduction in the risk of ascites (all were liver cancer patients) (p=0.008), 3 kg greater body weight (p=0.02), and 2-day shorter hospital stay (p=0.03) in the BCAAs group compared to the control.

No serious adverse events related to BCAAs and no safety concerns from observational studies were identified.

BCAAs supplementation use during the oncological peri-operative period revealed several significant beneficial effects. However, blinded, placebo-controlled confirmatory trials are warranted.

Probiotics are live beneficial microorganisms and they have shown promise in preventing some of the post-operative complications. Variations in probiotic interventions, the surgical settings, and the inconsistent results necessitate a comprehensive and rigorous synthesis review. This systematic review (SR) aims to evaluate the safety and efficacy of the use of probiotics in patients with cancer during the peri-operative period.

This SR conducted following a priori protocol registered in PROSPERO (CRD42018086168).

Forty -eight articles were included, reporting on 45 studies, comprising 37 RCTs (in 40 reports) and 8 observational cohort studies. A wide variety of multi-ingredient interventions were evaluated. Four of the interventions were used in 16 (43%) RCTs, while 21 out of 37 (57%) RCTs used unique products. Thirtyone (84%) RCTs investigated oral products, and 6 (16%) administered interventions by enteral tubes. Probiotic administration was used both pre-operatively and post-operatively in 20 (54%) RCTs. Thirty-three RCTs (92%) dealt with digestive system cancers. Twenty (54%) RCTs were conducted in Asia. Meta-analysis was not conducted due to the heterogeneity across the very diverse interventions. The preliminary results suggest a trend of possible beneficial effects of probiotics in reducing post-operative infections (29 RCTs included).

This SR includes 37 RCTs and provides the most comprehensive evidence synthesis on the use of probiotics during the oncological perioperative period. Further data synthesis is underway. 

There is a tendency towards lack of diagnosis and underestimation of late nausea; this could be corrected through a systematic telephone query at 

Upper gastrointestinal cancers are a significant health problem, with low survival and high symptom burden. Clinical care pathways could lead to reduced symptom burden and improve quality of life. Methods A standardised model for clinical pathway development was used, this included: 1) assembling a team of experts; 2) compiling and reviewing existing literature; and 3) developing the pathway via a consensus working group process. A Clinical Working Group (CWG) was convened from across ten public, private, metropolitan and regional health services in Victoria, Australia. Literature reviews were conducted to identify existing clinical symptom management and triage pathways or guidelines for patients with cancer as well as to identify any validated disease-specific patient-reported outcome measures in order to ascertain potential symptoms. Workshops were held with the CWG to develop the pathways.

Results 64 disease-specific symptoms were identified. The CWG finalised and approved 19 clinical pathways to manage these symptoms. Each clinical pathway includes an informed tailored clinical assessment of the symptom based on the NOPQRSTUV Symptom Assessment Acronym, triage of the symptom using the Common Terminology Criteria for Adverse Events (Version 5.0) and interventions for appropriate follow-up care.

A multidisciplinary approach and clinical consensus informed the development of evidence-based clinical pathways, which provide a standardised platform to appropriately manage and triage symptoms reported by people with upper gastrointestinal cancer. Brachytherapy for gynaecological cancer can cause pain, anxiety and distress. The aim of this study was to explore women's experiences of brachytherapy and to seek their views on improvements needed.

Semi-structured interviews were undertaken with women who had received brachytherapy for locally advanced cervical cancer at one of four UK sites. Two cohorts were recruited: cohort one had recently had brachytherapy and cohort two were a year post brachytherapy. Consecutive patients were invited to interview to minimise risk of bias. Interviews were audio-recorded and transcribed. Data were analysed following Braun and Clarke's method for reflexive thematic analysis (2006).

Thirty three interviews were conducted (18 cohort one and 15 cohort two). Age ranged from 28 to 87 years. Interview duration ranged from 22 to 78 minutes. Women's reports included difficult and traumatic experiences with periods of severe pain and poor nursing care on the wards. However, some women described positive experiences, reporting what had gone well. Three themes were developed, -see Table 1 .

Whilst some women had generally positive experiences of brachytherapy there are aspects of treatment that need to be improved to minimise difficult and traumatic experiences. Recommendations for improving holistic care of women receiving brachytherapy need to be developed. In the midst of the shift to outpatient care with increasingly shorter hospital stays, the development of outpatient surgery as well as outpatient oncology treatments, it has become common for oncology patients to return home with lengthy treatment and complex care.

In 2010, in the wake of an increasing activity at the Ambulatory consultation department, an organizational audit was carried out to improve working conditions and the quality of service provided to patients. The position of Post-Surgical Regulator Nurse was created in order to smooth out unscheduled surgical patient visits to Gustave Roussy. Several tools have been developed and validated by the surgeons in order to help the Post-Surgical Regulator Nurse in the patient referral process. A unique and dedicated telephone number is given to patients discharged post-surgery allowing them to contact this expert nurse for any postsurgery complications. This activity has rapidly grown with in the first year. In 2019, there was more than 4484 calls: 45% of patients were managed without needing to come back to Gustave Roussy, 46% of calls required an in person consultation and 10% were redirected to other services as per needed. In 2020, among the patients who had to come back for in person consultation, 20% required hospitalization without having to go through the emergency department. This is a long-lasting organization, essential for the proper patient post-op follow-up. Its effectiveness is no longer to be proven, but must be developed in order to adapt to the evolving post-oncological surgery patient care.

Cancer and its treatment incurs substantial out of pocket costs (OPC) and many patients cannot return to work or deplete savings sooner than anticipated. Australian non-profits such as Cancer Council offer financial support, however the attributes and experiences of service-users are largely unknown.

This cross-sectional study was part of a larger structured distress screening and referral trial. Eligible patients or carers contacted the Cancer Council phone-support service and scored >4 on the Distress Thermometer. At 3month follow up, participants reported discussion and use of financial services, OPC, income, demographic and clinical items.

Of 524 callers included, the majority were: female (77%), patients (56%), middle-aged (median 57yrs), married (65%), lived in major cities (73%), and held private insurance (60%). Median OPC in the past 3 months was $500; 29% reported OPC were higher than expected. Only 21% recalled discussing financial services during the call. Of these, only 32% used financial services. Of the 32%, 75% reported the service was very helpful. Variables significantly associated (p<.05) with discussing financial referral included age, marital status, disease stage, insurance coverage, employment status and absenteeism, and OPC.

Targeted screening to ensure those at high risk of financial toxicity are identified with timely and streamlined referral to appropriate services is needed. Results will inform development of a screening tool to improve outcomes for those at risk of financial toxicity. Variability in psychometric validation, measure structure (length, recall period), language availability and electronic availability was noted. Consideration of specific PROMs was based on them meeting combinations of the criteria above.

A core set of 116 validated PROMs is recommended for use in geriatric cancer care, targeting a wide range of symptoms and psychosocial issues. PROMs selected as 'fit for purpose' must capture the unique abilities of the geriatric patient population, including respondent burden and cognitive capacity.

Cancer patient caregivers may suffer from burden, with detriment to patients. Caregiver reported outcome (CRO) screening may yield benefits similar to those with patient reported outcomes. We aimed to describe how CROs might be integrated into care.

We focussed on colorectal cancer, which may have a long trajectory and pose significant caregiving challenges. Taking a qualitative Interpretive Description approach, our team of researchers, clinicians, and patient and caregiver research partners conducted and analyzed semi-structured interviews with 25 caregivers, 37 CRC patients and 16 healthcare providers (HCPs) using inductive coding and constant comparative techniques.

Patients and caregivers felt that, in response to CROs, HCPs must acknowledge caregivers and identify supports. Themes highlighting complexity in eliciting CROs included that caregiver burdens change over time, and that patient and caregivers may have contrasting perspectives on sharing CROs with patients, some valuing transparency and others preferring privacy. HCPs were aware that such variations exist and described strategies for assessing CROs.

It is important for HCPs to acknowledge and support caregivers. To prevent unintended burdens on caregivers and patients, integration of CROs into care should relate factors impacting caregivers, including the point in the disease trajectory and caregiver and patient preferences regarding transparency or privacy of CROs. 

A N O V E L C A R D I A C A R R E S T C A R D I O -O N C O L O G YMORTALITY

There are no mortality prediction scores for post-cardiac arrest cardiooncology patients validated in a nationally representative dataset, which severely undermines informed supportive care discussions.

Artificial intelligence-driven Computational Ethical (AiCE) analysis was conducted by (1) generating and validating the post-Cardiac Arrest Cardio-Oncology Score (CACOS) with the 2016 National Inpatient Sample to then inform (2) Figure 1 ). CACOS included the following predictors (and points): no percutaneous coronary intervention (5), metastatic cancer (2), age >=75 (2), active cancer (2), and female (1). Mortality was most significantly increased by pancreatic, liver and biliary, and lung malignancy among all primary malignancies. AiCE indicated that individual and population good is optimized by considering discussion of comfort measures for patients with increasing CACOS.

Conclusions CACOS may accurately predict post-arrest mortality with commonly available variables in a nationally representative sample to guide empirically and ethically optimized supportive care discussions. 

Radio-chemotherapy (RCT) is the best option for resected high risk or locally advanced head and neck squamous carcinomas (HNSCCs). Poor adherence to treatment has a negative impact on patient outcome. RCT is frequently associated with systemic toxicities, especially anorexia and weight loss, resulting in a treatment discontinuation rate ranging between 20-40%. Aim of our study was to retrospectively assess whether an adequate daily intravenous hydration has an impact on treatment withdrawal rate.

We collected data from 35 patients (pts) with stage II-IV HNSCCs, treated with RCT with cisplatin 100 mg/mq d1w21, from January 2017 to December 2020 in our institution. All pts received daily intravenous 1000 ml saline solution from day 10 after the start of RCT until the end of treatment.

The mean age was 63 years (range 42-77), 74% male. At least 2 cycles of chemotherapy were administered in 94% of pts. Only 23% of pts suffered from G3 oral mucositis. Anorexia G3 was observed in 40% of pts, without leading to treatment discontinuation. There were no hospitalizations during RCT. 80% of pts received intravenous steroids and only 31% of pts received tube feeding or total parenteral nutrition. The majority of pts (77%) underwent supportive treatment with home care assistance. Only 14% of pts interrupted radiotherapy, mostly for toxicity. (Table 1 ) Conclusions These preliminary data suggest that daily intravenous hydration during RCT decreases the treatment discontinuation rate, handling toxicity and preventing hospitalization.

A. Petranović 1 , D. Petranović 2

Mindfulness interventions have been linked to various positive outcomes in cancer patients. Reduced anxiety and depression symptoms, improved mood, sleep quality and general well-being are some of the benefits that were found in different studies. It doesn't come as a surprise that today more and more hospitals are implementing different types of mindfulness interventions into their supportive care routines for patients. Mindfulness-Based Stress Reduction (MBSR) is a structured psychoeducational therapy package that combines mindfulness meditation with yoga and it was proven multiple times to improve physical and psychological symptoms in cancer patients.

Our suggestion is to include approximately 70 oncological in-patients and out-patients in 8-week MBSR program which is consisted of three formal techniques: mindfulness meditation, body scanning and simple yoga postures.

The program would be led by a certified trainer and hospital staff would be educated on how to help with the program implementation from their position. We expect positive effects on physical (sleep quality, fatigue, cortisol levels) and psychological (anxiety, mood, stress levels, post traumatic growth) well-being of patients.

Based on the results, practical and theoretical guideliness and suggestions for future research will be given.

Conclusions will be given after the completion of the program. It is expected, based on previous research, that there will be different positive effects on physical and psychological well-being of patients.

Poor physical performance and negative mood are risk factors for functional decline among older adults with lung cancer. Our primary objective is to assess the feasibility of a virtual health (VH) physical therapy (PT) plus progressive muscle relaxation (PMR) intervention delivered to older adults with advanced lung cancer.

An ongoing prospective cohort accruing adults aged ≥60 years with advanced non-small cell or small cell lung cancer receiving treatment at the James Thoracic Oncology Center (planned enrollment N=30). Feasibility will be defined as: recruitment, retention, and completion rates. PT and psychologists evaluate participants in-person at the start and end of the 12-week intervention with the remainder conducted via VH.

Despite COVID -19 pandemic barriers, our team was able continue the study using a VH platform. At interim analysis, 22 patients have been consented; 18 started the intervention (dropout rate=18%). Among the 18 participants, 4 withdrew prior to completion; 1 due to a severe decrease in performance status causing safety concerns, 2 due to an overwhelming amount of other healthcare visits associated with disease progression and 1 due to death. 8 participants have completed the intervention in full with an additional 6 participants on study. Feasibility metrics will be reported at the conference.

This intervention is potentially feasible despite the challenges of the COVID-19 pandemic among older adults with advanced lung cancer.

Emergency departments (ED) are considered sub-optimal to satisfy the needs of cancer patients. Various international groups have developed strategies to improve the acute attention of cancer patients. This study aims to review the existing evidence on the effectivity of various innovative models of care for cancer emergency attention.

Literature review of seven databases during the period 2000-2019, including articles published in English and Spanish.

A total of 10 articles were included: four descriptive studies, three quasi-experimental studies, two retrospective studies, and a qualitative study. They described new strategies in common ED clinical pathways or the creation of specialized units for the attention of cancer emergencies. The authors report reductions in the number of admissions, length of hospital stay and, furthermore, cost reductions. A previous triage and telephone attention service is considered key to increase the efficiency of the interventions. The authors reflect the importance of multidisciplinary attention, early integration of palliative care, and effective coordination with community services.

Enhancing the care of cancer patients who require emergency attention is possible through the creation of specific pathways or dedicated units staffed with professionals who are knowledgeable about cancer complications and treatment secondary effects. Specialized emergency cancer units seem to be a feasible and safe alternative to EDs, preventing overcrowding in the ED and avoiding unnecessary hospital admissions.

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

As most of researchers in laboratory seldom have a chance to talk to survivors, their customers are thought to be physicians, but not patients.

The end-users of medicines are patients. Therefore, researchers should try to understand their real customers' needs. Moreover, if they want to design a clinical trial, the aim of which should be the promotion of patients' satisfaction. In order to encourage researchers to talk with patients, we established International Society of Patient-Centered Oncology Science (ISPACOS) in 2018.

At first, we recruited people whose interest was Patient-Centered cancer care Then, we started to have a monthly meeting to discuss about the themes for symposium. We also gave a lecture why the physicians are not substitutes for patients. In 2020, all the events were held virtually.

Early in 2019, only ten people gathered, however, at the end of 2018, over 80 people participated in the 1st symposium, the 2nd symposium collected 150 people and over 200 had accessed the WEB symposium in 2020. The 3rd and 5th symposium were held in Bangkok, and people from China, Cambodia participated in the 4th one to present their COVID-19 situation. Our activity has been selected by Juntendo University as a branding project and now funded by the university.

The 6th symposium will be held virtually to discuss about medical recording system in Sweden, Singapore, China, Thailand and Japan to learn which is the best one for the life-long cancer care and the big-data supportive study for the future contribution. The aim of this experimental study is to evaluate the effect of nurse navigation in the management of symptoms associated with head and neck radiotherapy. Between November 2018 and January 2020, 88 people, 41 of whom were in the experimental group and 47 were in the control group, were included in the study. The standard approach of the hospital was applied to all patients. Nursing navigation was applied in addition to the patients in the experimental group. As a pre-test for all patients included in the study just before starting treatment; informed consent form, patient diagnosis form, CTCAE v5.0 toxicity criteria and EORTC QLQ-H & N35 quality of life scale were applied. It was observed that the severity of mucositis, pain in the mouth, dysphagia, and weight loss was statistically significantly decreased in the experimental group compared to the control group, and the quality of life scores were found to be significantly increased. As a result of this study, it was determined that navigation nursing is an effective approach for patients receiving head and neck radiotherapy. Optimal care of patients living with advanced cancer requires a collaborative approach between oncologists and family physicians (FPs). We developed and implemented "Advanced Cancer Shared Care (ACSC) letters" to improve communication, collaboration and role clarity.

A physician-to-physician standardized "ACSC letter" for colorectal cancer was created at a Canadian tertiary cancer center with stakeholder input. It is ordered by an oncologist when they determine a patient to have advanced cancer. The letter outlines shared care components like division of responsibilities, and how to access palliative services. FPs can return a cover sheet to confirm their involvement, indicate their comfort level with providing a palliative approach to care and ask questions. After 4 months of piloting, sustainability metrics were collected over 8 months.

After 8 months, all 8 gastrointestinal oncologists continued to use it, with 28.7% of patient visits (41.3% of decedent cohort) having an ACSC letter ordered. Cover sheets were returned in 23.3% of cases. Content returned included prognosis questions, goals of care conversations, supportive services available in their practice and those in use by the patient, capacity to manage symptoms (e.g. opioid prescribing), and palliative consult requests.

The ACSC letter provides a useful mechanism for FPs and oncologists to share information. It increases communication and care coordination between typically siloed providers, to enhance patient experience.

The COVID 19 pandemic has impacted the whole world.

Continuing medical care to children with cancer during this pandemic is a challenging task. Anticipating high incidence of default during this pandemic, we formulated a multi tier supportive care model with NGOs for financial and social support for treatment, travel and accommodation. Unit policies were adopted to minimize the risk of acquiring infection in both children undergoing cancer treatment as well as health care workers.

We did a retrospective descriptive study from March to December 2020 to assess the effectiveness of supportive care implemented for management of children with cancer during this pandemic.

A total 651 pediatric oncology admissions were made. Seventy one cases were newly diagnosed and 56 of them initiated treatment at our centre. Only 10 children were found to be covid positive and all of them were asymptomatic. An amount of 87865.74 USD collected from various sources were utilized for treatment of cancer children and hospital administration waived off 17010.94 USD to help families manage financial toxicity. Only 6 families who had ongoing treatment defaulted. No doctors in the treating unit were infected and only 2 of the nursing staff were found to be positive and both recovered uneventfully.

With good supportive care model strategies including NGOs, efficient hospital administrative policies and shared care practices, we could deliver essential pediatric oncologic services with minimal impact even during COVID pandemic. 

The goal was to investigate sociodemographic, medical and counselingrelated determinants of post-diagnosis physical activity (PA) among cancer patients.

Overall, 912 cancer patients (457 breast, 241 prostate, 214 colorectal) self-reported their pre-and post-diagnosis PA behavior, sociodemographic and medical variables, as well as their perception of physicians' counseling regarding PA behavior via a comprehensive questionnaire. Adjusted regression and classification tree analyses were used to investigate PA determinants and detect subgroups that were most likely to be active.

Across cancer types, 54.1% of participants reported to meet postdiagnosis PA guidelines. While post-diagnosis PA was strongly affected by previous PA among all patient groups, other sociodemographic and medical determinants played different roles depending on cancer type. Previously active, longer diagnosed patients with higher education levels were most likely to meet PA guidelines post-diagnosis. Specifically previously inactive prostate cancer patients had an increased risk of insufficient activity. A more comprehensive counseling was significantly associated with higher post-diagnosis levels (p<0.01), with stronger associations for breast (p=0.01) and colorectal cancer (p<0.01) than prostate cancer (p=0.05).

The results pave the way for more tailored interventions along the patient characteristics and cancer types, as different factors are associated with PA for each patient group.

The delivery of chemotherapy in outpatient settings necessitates patients and carers managing chemotherapy side effects at home. A shared care model was developed with community nurses (CNs) providing in-home care to patients to improve symptom control, reduce unplanned readmission and facilitate communication with cancer services and primary care.

Chemotherapy outpatients (n=346) were randomised to either homebased supportive care visits from CNs during the first 3 cycles of chemotherapy, or usual care. Clinical data relating to unplanned presentations and Patient Reported Outcome Measures (PROMs), were collected at four timepoints. Interviews were conducted with patients, CNs, and health care professionals (HCP).

There was an 11% (95% CI .641 -1.235) relative reduction in unplanned presentations in the intervention group vs control group. In both groups, presentations were mainly due to chemotherapy related symptoms. Presentations for nausea and vomiting were significantly reduced in the intervention group compared with usual care (1 vs 12, p<.003). Cancer self-efficacy was statistically improved in the intervention group (P= 0.01). Qualitative findings from patients and carers showed strong support for CN visits. CNs reported the education program increased their confidence.

Coagulopathy developing in patients (pts) 

Mucositis is a common side effect of cancer chemotherapy with limited prevention options. We assess the protective effect of rosuvastatin (ROSV), with its pleiotropic effects, on 5-fluorouracil (FU)-induced intestinal mucositis in rats.

Fifty Wistar rats (205±21g) were divided into five groups; control (normal saline), ROSV (20 mg/kg; oral), FU (50 mg/kg; i.p.), FU+ROSV 10 (50 and 10 mg/kg) and FU+ROSV 20 (50 and 20 mg/kg). Body weight, food/water intake, diarrhea was assessed daily. Histopathological examination of jejunum was done to reach a histological damage index (HDI). Contractile responses to acetylcholine (Ach) were assessed using isolated organ bath. Results FU induced severe significant weight loss, increased water/decreased food intake and increased diarrhea score (P< 0.001) compared to control group. ROSV 10 mg reversed all FU induced symptoms (P< 0.001), however ROSV 20 did not significantly decrease weight loss (p= 0.56) or water intake (p= 0.11). Histologically, FU significantly reduced villus length and increased HDI (P< 0.001). ROSV 10 significantly reduced HDI (p= 0.04) and improved villi length (p= 0.03). Although ROSV 20 significantly improved villi length, it did not significantly reduce HDI (P= 0.78). Contractile responses to Ach were increased in FU group compared

The role of the gut microbiome in radiotherapy-associated mucosal inflammation and immune signaling is an area of high interest. As such, this study aimed to determine whether depleting the gut microbiota has an impact on the development and severity of radiation-induced oral mucositis (OM) in a rat model. Methods 24 male Sprague Dawley rats were divided into two groups; antibioticinduced microbiome depletion+radiation group (AIMD+Rx, n=12) and radiation only (Rx, n=12). To deplete gut microbiota, AIMD+Rx rats were treated with an antibiotic cocktail for three weeks in drinking water.

All rats were exposed to 20 Gy x-ray radiation to the snout. Rats were culled on day 9 and 15 post-radiation and tongue was collected for the assessment of OM and inflammatory markers.

The duration of severe OM (grade 4-5) was significantly shorter in AIMD+Rx rats (2±0.3 days) compared to Rx only rats (3.5±0.5 days) (p=0.04). Moreover, the area of ulcerated mucosa was smaller in AIMD+ Rx (18.9%) compared to Rx (33.3%) (p=0.02). Microscopically, a smaller ulcer size on the mucosa of the dorsal tongue was observed in AIMD+ Rx compared to Rx (p= 0.002). Compared to Rx group, AIMD+Rx group had significantly lower levels of IL-6 (p= 0.04) and IL-1β (p= 0.02) in lingual tissues on day 9 post-radiation.

Gut microbiota plays a role in OM pathogenesis, particularly in the healing phase, through the modulation of pro-inflammatory cytokines. Future microbiota-targeted therapies may improve OM in clinical settings.

Oral Proffered Paper

Emerging evidence suggests that gut microbiome may play a role in radiotherapy (RT) antitumour response and toxicities through modulation of immune signalling and inflammatory responses. However, this has not been studied in the context of head and neck cancer (HNC). This study, therefore, aimed to assess the impact of an individual's baseline gut microbiome composition on RT response and oral mucositis (OM) severity in patients with HNC. Methods 20 patients scheduled to receive RT or chemoradiotherapy (CRT) were recruited from a single site. Pre-therapy stool samples were collected with microbial composition analysed using 16S rRNA sequencing. OM severity and treatment response were obtained from symptom questionnaires and medical records respectively.

Baseline characteristics were as follows: 80% males with median age of 66, smoking status (Non-smoker=6; Ex-smoker=11; Smoker=3); recent antibi-otics=8; cancer type (Oral cavity=4; Nasal cavity=2; Oropharyngeal=5; Salivary gland=6; others=3). 80% of patients were treated with RT alone and 20% treated with CRT. Overall, patients received between 36 and 70 Gy in 6 to 30 fractions. Gut microbiome composition is currently being analysed and will be presented at the conference.

Based on the current evidence, we anticipate that patients with a more diverse gut microbiome will have a better response to treatment and less severe OM, providing an opportunity to predict RT efficacy and toxicity, and personalise treatment to optimise outcome.

Oral mucositis (OM) is a complex acute cytotoxicity of antineoplastic treatment that affects 40-85% of patients undergoing hematopoietic stem-cell transplantation. Incidence of OM is associated with prolonged hospitalization, extensive analgesic pharmacotherapy, parenteral nutrition and elevated treatment costs. In this context, the identification of patientsrisks for OM is fundamental to enhance supportive care in oncology. As OM onset relies on mucosal microenvironment status, with a possible role of microbiota-driven inflammation, we aimed to investigate whether the oral mucosa microbiota was associated with the clinical course of OM.

We collected oral mucosa samples from 30 patients undergoing allogeneic hematopoietic stem cell transplantation at preconditioning. During the period of the study, 13/30 patients developed OM. For those patients, additional oral mucosa samples were collected at OM ulceration onset and ulcerated OM healing. All the samples were characterized by 16S rRNA sequencing.

We observed that specific taxa were associated with OM risk, severity and time to resolution. In particular, at preconditioning, higher relative abundance of Porphyromonas was positively correlated with ulcerated OM grade (rho=0.605, p=0.028). Additionally, we observed that higher relative abundance of Lactobacillus was associated with shortened ulcerated OM duration (p=0.032).

Our findings suggest that further research should focus on evaluating the influence of host-microbiome interactions on OM pathophysiology. 

Oral mucositis (OM) is an acute side effect of the cytotoxic cancer treatment that is particularly severe in patients undergoing head and neck radiotherapy (RT). This study aimed to assess the impact of prophylactic extraoral photobiomodulation (PBM) therapy for OM on clinical outcomes and survival in patients with oral cavity and oropharyngeal squamous cell carcinoma (OSCC).

OSCC patients who received RT with curative intent were randomized into two groups. One received prophylactic extraoral PBM (LED 69 diode, 34x660 nm and 35x850 nm, 1390 mW, energy density 50 mW/ cm2, 3.0J of energy/cm2, 60s/spot), and the other placebo. OM grade (NCI, Version 4.0), pain (VAS), analgesia, and anti-inflammatory prescriptions were assessed weekly. Quality of life (QoL) evaluations were performed at the first and last days of RT. The impact of the PBM upon cancer treatment outcomes were evaluated quarterly following RT. Results 55 patients were included. Later OM onset, lower mean pain scores, less analgesics and anti-inflammatory prescriptions were observed for the PBM group. Better QoL scores were observed for the PBM group. There was no significant adverse side effects or impact on the overall survival.

Prophylactic extraoral PBM may be effective and safe for mitigating OM outcomes in OSCC patients.

The aim of this study was to assess the efficacy and safety of Dentoxol mouthrinse in reducing the severity of oral mucositis (OM) secondary to radiation therapy (RT) for head and neck cancer. Methods A randomized, double-blind, placebo-controlled, multicenter Phase II clinical trial was conducted. Subjects were asked to use Dentoxol (n=55) or control (n=53) mouthrinse 5 times/day during RT. Twice a week, OM was assessed clinically using the WHO scale and the Oral Mucositis Daily Questionnaire (OMDQ) was completed.

The incidence of severe OM was 40.7% in the Dentoxol group and 51% in the control group (p=0.265). Comparing all recorded clinical assessments, severe OM was seen in 13.3% of all assessments in the Dentoxol group vs. 21.8% in the control group (p=0.000). There was a statistically significant lower proportion of assessments showing severe OM in the Dentoxol group at weeks 4, 5 and 6 of RT. The mean duration of severe OM was 11.95 days in the Dentoxol group vs. 14.59 days in the control group (p=0.502). There was no difference between groups in mouth pain and its impact on function. The use of Dentoxol was safe and was not linked to any serious adverse events.

The use of Dentoxol 5 times/day is safe and resulted in significantly fewer time-points with severe OM and a delay in the onset of severe OM, as compared to a control rinse. A Phase III clinical trial is warranted to confirm efficacy and address the limitations of this study. Clonidine mucobuccal tablet (clonidine MBT) is a novel formulation of the 2-adrenergic receptor agonist, clonidine HCl, that is being developed as a novel agent for the prevention of chemoradiation (CRT)-induced SOM. It adheres to the gums and releases clonidine HCl locally. Clonidine is thought to suppress local expression of pro-inflammatory cytokines after CRT, leading to a decreased incidence of SOM. Neratinib is an irreversible pan-HER tyrosine kinase inhibitor used for extended adjuvant treatment of HER2+ breast cancer. Diarrhea is frequently observed with this agent. We have previously shown that neratinib-induced diarrhea is associated with alterations to the gut microbiome in a rat model. This study aimed to evaluate contribution of specific gut microbiota in the development of neratinib-induced diarrhea using different classes of oral antibiotics.

Female Albino Wistar rats (n=48) were treated daily with 50 mg/kg neratinib or vehicle control (0.5% hydroxypropyl methylcellulose) for 28 days. Antibiotics (vancomycin (0.5g/L), neomycin (1g/L) or an antibiotic cocktail (vancomycin 0.5g/L, neomycin 1g/L and ampicillin 1g/L)) were administered via drinking water sweetened with 0.75g/L sucralose throughout the study, beginning three weeks prior to neratinib. Diarrhea was scored from 0-3.

Neratinib-induced moderate diarrhea decreased from 13.8±1.6 days to 2.3 ±1.8 days in the antibiotic cocktail group (p>0.05), 0.3±0.16 days by vancomycin (p=0.001) and 0±0 days for neomycin (p<0.0001). Neratinib-treated rats gained significantly less weight than rats treated with neratinib + vancomycin (p=0.0077) and neratinib + neomycin (p=0.0161).

Ablation of the microbiome by narrow spectrum antibiotics caused improvement in weight and diarrhea scores compared to an antibiotic cocktail. These findings warrant investigation of how the microbiome could be targeted clinically to mitigate neratinib-associated gastrointestinal events.

Oral FMT was prepared using faeces collected in acclimatisation and administered by oral gavage. Primary outcome was plasma citrulline.

FMT stabilized the microbiome after MTX but did not have any appreciable impact on GI-M. In contrast, disruption of the microbiome with antibiotics administered before chemotherapy exacerbated GI-M, impairing mucosal recovery (P<0.0001), increasing diarrhea severity (P=0.0007) and treatment-related mortality (P=0.0045). These detrimental effects were reversed with autologous FMT (P=0.03); a phenomenon associated with the uptake and subsequent expansion of Muribacteraeae.

Augmenting the microbiome predictably changes the symptoms of GI-M suggesting causal mechanisms. New strategies targeting the microbiome should focus on stabilizing its compositions before chemotherapy to accelerate recovery of the mucosa. ) or vehicle (n = 6-8 per group). The primary outcomes of GIM were change in body weight and diarrhoea, and the outcome for chemoefficacy was tumour size (cm^3). All assessments were taken for 72 hours post treatment.

Irinotecan caused moderate GIM characterised by weight loss and diarrhoea in both Tlr4ΔIEC and WT mice. Tlr4ΔIEC mice were protected from diarrhoea compared to WT 24 h after irinotecan (P < 0.0001). Significant weight loss was observed following irinotecan treatment in both strains of mice (WT P = 0.0071, Tlr4ΔIEC P = 0.0011), however there was no difference in weight loss between WT treated and Tlr4ΔIEC treated mice. Tumour burden did not differ between groups (P > 0.05).

Intestinal epithelial TLR4 plays a more in-depth role in GIM development than previously suspected, with our data suggesting a more potent role for TLR4 expressed on immune cells. 

Photobiomodulation therapy has been shown to be an effective treatment for reducing the incidence and severity of oral mucositis (OM). The objective of this study is to determine the range of effective PBM dose, and review the adequacy of reporting irradiation parameters.

Online databases were searched to compare efficacy of PBM versus controls for preventing or treating cancer therapy-induced OM. Irradiation parameters were reviewed for accuracy.

A total of 53 clinical trials were identified and 29 papers were excluded, leaving 24 papers for review. Only 1 study reported all parameters accurately. Seven studies reported a difference in OM grade ≥ 3 (WHO) between the placebo and PBM groups greater than 40% when PBM was used prophylactically with greater irradiation parameters (mean energy dose 50%, beam area 58%, irradiance 246%, and treatment time per point 290% greater than the overall mean values). A plot of effect size (%) vs. total energy per session was created using studies that reported adequate information to determine both total energy per session and the difference in the percent of patients with OM grade ≥ 3 between the study group and placebo group. These data points were fit with a quadratic curve to evaluate if the data may resemble the parabolic relationship observed in previous studies.

This review has reconfirmed the lack of accurate reporting of PBM parameters. Total energy per session may be used to guide PBM dose parameters. 

Severe OM (SOM) is recognized as a significant toxicity of concomitant CRT used to treat HNC. There is no approved intervention. Oxidative stress is a critical event in CRT pathogenesis. ST617 a dithiolethione targeting Nrf2 has anti-oxidative activity and has previously been studied in humans. It's developed for the attenuation of OM onset, duration and severity Methods Phase 1b evaluates 3 doses of ST617 for safety, tolerability, PK, PD. Efficacy was performed in HNC pts receiving standard CRT. The oral suspension was administered 3 days prior to CRT, then daily, 1-2 hrs prior to CRT until end of RT. Safety outcomes, using standard CTCAE criteria were used. Doses were escalated in absence of dose-limiting toxicity (DLT). OM was assessed twice weekly by trained evaluators and scored centrally using WHO, NCI-CTC and RTOG scales. The primary efficacy endpoint was reduction in SOM (WHO grades 3/4) incidence & duration vs historical controls. PD measured peripheral blood and oral mucosa comparative ROS/RNS and GSH/GSSG gene expression Results 17 pts completed the trial at 50 (n=6), 100 (n=8) and 150mg/day (n=3 

One of the most common adverse event (AE) of everolimus is mucositis. This AE led to dose reductions and interruptions of the treatment. The aim of the study is to develop a 0.5 mg / 5ml dexamethasone mouthwash formulation and to evaluate its effectiveness as prophylaxis for oral mucositis secondary to the treatment of everolimus.

The mouthwash was prepared by taking the following raw materials: 20 milligrams of dexamethasone, 30 grams of glycerol, 2 grams of carboxymethyl cellulose, 2 drops of Tween 20® and q.s. for 200 milliliters of purified water. The suspension was conditioned in opaque jars. The validity period assigned was 14 days at temperature between 2 and 8°C (deadline based on the matrix of non-sterile preparations of the Guide to Good Practice).

The effectiveness was evaluated with variables such as frequency of administration, degree of mucositis (scale of the World Health Organization) and discontinuation of everolimus.

A homogeneous suspension was obtained. 8 patients were enrolled. They received everolimus with indication of breast, kidney or pancreas cancer. They used mouthwashes three times daily for 8 weeks.

Only two patients presented grade 1 mucositis and it subsided after two weeks. Seven patients discontinued the treatment but the causes were not mucositis.

Prophylactic use of dexamethasone mouthwawsh in combination with proper oral hygiene was effective and significantly reduced the incidence and severity of stomatitis refractory to the treatment of everolimus.

Gastrointestinal mucositis is one of the most prevalent clinical challenge in the acute phase of allogeneic hematopoietic stem cell transplantation (HSCT) and has been pointed out as one of the main causes of dietary supplementation and opioid use. The objective of this study was to evaluate the impact of the use of Sucralfate (suspension) in the management of odynophagia during the acute phase of allogeneic HSCT in the dietary supplementation and opioid use.

Methods A case-control study was conducted in order to compare the use of parenteral nutrition, Tramadol, Morphine, Peitidine, Pacth Fentanyl and Hexamedine between the control and the study group (sucralfate). The 39 patients allocated in each group were followed from the beginning of the conditioning regimen to the neutrophilic recoverage.

The groups were similar in conditioning regimen (p:1,00); underline disease (p:0,94); gender (p:0,36); age (p:0.65); weight (p:0.98) and mucositis (incidence and severity-p:0,33 Introduction Avasopasem manganese (GC4419; AVA), a dismutase mimetic, at a dose of 90mg vs placebo (PBO), resulted in significant reduction in duration and clinically meaningful reduction in incidence and severity of severe oral mucositis (SOM) (WHO grade 3/4, inhibits nutritional intake) in a Phase 2b study (Anderson JCO 2019) . Here, we report on exploratory endpoints (narcotics use, G-tube placement) from the study (NCT02508389).

Randomized, double-blind trial of patients with head and neck cancer treated with intensity-modulated radiation therapy (IMRT) plus cisplatin randomly assigned to receive 30mg or 90mg AVA or PBO by 60-minute IV administration before each IMRT fraction.

The treated population included 217 patients. 188 (87%) took ≥1 dose of a narcotic, with a similar percentage in each arm (Table 1) . Overall, median total morphine equivalent per patient was 848mg (PBO), 818mg (AVA 30mg), and 752mg (AVA 90mg). Among 112 patients who had ≥1 observation of SOM and took ≥1 dose of a narcotic, the median total morphine equivalent per patient was 1410mg (PBO), 1053mg (AVA 30mg), and 752mg (AVA 90mg). G-tubes were placed in 34 (47%), 34 (47%), and 28 (39%) patients prior to day 1, and 16 (22%), 20 (27%), and 13 (18%) patients after day 1 in the PBO, AVA 30mg, and AVA 90mg groups, respectively.

Exploratory data suggest AVA may be associated with decreased need for narcotic use and G-tubes in patients with SOM. Additional assessment is warranted. 

Oral mucositis (OM) is a significant side-effect of cancer treatment. The purpose of this study was to compare topically administered Caphosol to saline oral rinses in the prevention of OM in pediatric cancer patients undergoing chemotherapy. Methods A controlled, double-blinded and randomized clinical study recruited patients between 2 to 17.99 years of age who were diagnosed with a malignancy and were receiving either high-dose methotrexate, anthracycline or cisplatin chemotherapy (NCT0280733). All patients received two seven-day cycles of the mouth rinses, i.e. one cycle of Caphosol and one cycle of saline in a randomized order. Oral changes and symptoms were evaluated using the World Health Organisation (WHO) toxicity scale and the Children's International Mucositis Evaluation Scale (ChIMES) scale. The primary endpoint was the frequency and severity of OM and oral symptoms.

A total of 56 patients were recruited to the study, of whom 45 were randomized, with a median age of 6.5 years (range 2.1 to 17.1 years). No cases of severe OM were observed. Grade ≥3 oral symptoms were present at least once in 6 (13%) patients during the Caphosol cycle and 13 (29%) patients during the saline cycle (p=0.12). The peak of symptom scores was evident at around day 4 to 7 after administration of the chemotherapy with no marked differences between the rinse solutions. Multivariable regression analysis did not indicate a benefit of using Caphosol over the saline solution.

Caphosol rinse was not superior to saline in preventing OM or associated symptoms.

Oral mucositis (OM) is a common side effect of chemotherapy that affects approximately 80% of pediatric cancer patients. Management of OM is still controversial. Among non-pharmacological therapies, exposure to low ozone (O3) concentrations has a therapeutic effect in many diseases.

The aim of this pilot study was to investigate the effectiveness of ozonized water in the treatment of OM in childhood.

Patients 4 to 18 years old, undergoing cancer therapy and presenting OM (grade≥2) were enrolled and randomized into two treatment groups. All patients received conventional hyaluronic coating gel treatment. In addition, patients from group A received ozonized water treatment as 4minute oral rinses (double-distilled water to ozone ratio being 2:3), for 4 consecutive days. Patients from group B received placebo treatment (double-distilled water rinses) following the same protocol. OM WHO grade and VAS 0-10 pain evaluation were performed at day 1 (at diagnosis -T0), day 4 (at the end of the treatment -T1) and at day 7 (T2).

A total of 19 patients were included in the study (group A: n=10; group B: n=9). Both groups showed a decline of OM grade, being greater in group A, but the difference between groups was not statistically significant (p> 0.05). VAS pain score was significantly lower in group A both at T1 and at T2 (p < 0.05).

Ozonized water treatment seems to be effective in reducing OM-related pain in children. Oral mucositis (OM) is a common side effect of conditioning therapy in hematopoietic stem cell transplant (HSCT) patients. Using exome sequencing, we had previously found ten candidate genes with OMassociated single nucleotide polymorphisms (SNPs) in 63 HSCT-patients. SNPs of nine genes were confirmed by targeted PCR-next generation sequencing (NGS) with 99.3% accuracy, but the rs17650 SNP in orosomucoid-1 (ORM1) gene was not confirmed in 38 patients. Our objective was to explore the cause(s) and to confirm rs17650 SNP using an alternative method.

A custom Taqman assay was designed for ORM1 using saliva DNA of patients (N=63). Assay accuracy was determined using the exome sequencing results. To verify hybridization of PCR-NGS primers, Fastqc-v0.11.5 and Trimmomatic-v0.38 were used for QC. Sequence reads aligned to ORM1 sequence were identified using bwa-v0.7.1 and SAMtools-v1.4. Forward and reverse primer sequences were compared to reads using BLAST.

Custom Taqman assay confirmed 87.3% ORM1 rs17650 genotypes including those conferring susceptibility to OM. A T-to-C mutation within reverse primer sequence location was identified in ORM1 first-intron for 90% HSCT patients.

Validation of OM-associated SNPs requires various genotyping assays. In addition to the potential role of rs17650 SNP in OM susceptibility, the effect of first-intron T-to-C transition mutation on ORM1 remains to be elucidated. Introduction Oral mucositis and taste disturbance are common complications during hematopoietic stem cell transplantation (HSCT). This study aimed to review the incidence of severe mucositis and taste disturbance in patients undergoing different HSCT regimens.

This single-center retrospective study reviewed daily oral assessment for 467 consecutive patients who received HSCT. Oral care and cryotherapy with melphalan were used. Oral mucositis WHO grade, taste disturbance, use of total parenteral nutrition (TPN) and patient-controlled analgesia (PCA) were collected.

Grade 3-4 oral mucositis was common in myeloablative total body irradiation (TBI) based regimens, CyTBI with post-transplant methotrexate (PTMTX) (71%) and FluTBI with post-transplant Cy (PTCy) (46%) as well as reduced intensity FluMel with PTMTX (43%) and BEAM autologous HSCT (41%). In contrast, Grade 3-4 oral mucositis was less common in reduced intensity haploidentical regimen MelFluTBI with PTCy (19%), all non-myeloablative regimens, FluCy with PTMTX (9%), FluTBI (0%) and FluCyTBI with PTCy (0%) and high dose melphalan autologous HSCT (26%). TPN and PCA uses were corelated with oral mucositis severity. Taste disturbance was common regardless of the regimens (89%, range 71-95%).

Severe oral mucositis was associated with myeloablative TBI, PTMTX and melphalan in combination with PTMTX and in BEAM. Use of PTCy was preferable over PTMTX to prevent oral mucositis. Taste disturbance was common with all regimens.

Oral mucositis is a common complication in patients undergoing hematopoietic stem cell transplantation. Accurate oral mucositis grading is essential for both clinical practice and oral mucositis research. This study aimed to evaluate the accuracy of daily oral mucositis grading by nurses in a tertiary hospital in Australia.

A retrospective study was undertaken to review the daily patient oral assessment record, including diet, pain, erythema ulceration and the oral mucositis grade based on World Health Organization (WHO) oral mucositis grading scale. The accuracy of the grade was determined by the observations recorded and reasons for inaccuracy was documented. Any repetition of the same error in the same patient was noted.

In total, 6841 oral assessments in 373 patients, conducted between 2017 and 2020, were reviewed. A total of 70% (N=4781) were graded correctly. Of these 64% (N=3043) were grade 0. When the grade 0 scores were excluded, the accuracy of grading was reduced to 46% (N=1738). Common reasons for incorrect grading included; unable to grade due to diet not specified, no ulceration and no pain was scored grade 1, no ulceration was scored as grade 2-4, oral intake was not taken into account, and pain without ulcer was scored 0. A total of 77% of the errors were repeated in the same patient on consecutive days.

Our results suggest there is frequent inaccurate evaluation of oral mucositis and a need for nurse training to accurately assess oral mucositis. Claudin-2 expression in ileum and colon tissues was quantified using real-time PCR (relative fold-change) and immunofluorescence (percentage area staining). Colonic permeability (resistance) was measured in Ussing chambers.

Claudin-2 was significantly lower in control versus treated Tlr4ΔIEC mice (control: -6.6-fold-change versus treated: 0.7-fold-change, p = 0.016). Epithelial resistance was reduced by irinotecan in WT but not Tlr4ΔIEC mice (p = 0.01).

Irinotecan-induced GIM is associated with elevated colonic claudin-2 in Tlr4ΔIEC mice, which may reflect the action of TLR4-expressing immune cell infiltration. Given that protein levels and barrier functions appeared stable during treatment in Tlr4ΔIEC mice, further tissue analysis is required before more robust conclusions can be drawn on role of claudin-2 in response to irinotecan. 

Changes in microcirculation of the oral mucosa are due to injury to endothelocytes, precede the clinically detected manifestations of oral mucositis (OM) related to radiotherapy and can be assessed using Laser Doppler Flowmetry (LDF). We aim to evaluate changes in blood flow (BF) in the genial region in patients at high risk of developing OM submitted to radiotherapy (RT) in the head and neck region, concomitant or not with chemotherapy, relating the BF with the degree of OM and pain. Methods BF measurement was performed using LDF previously at RT and in weekly assessments for 7 weeks during RT, OM was clinically assessed using the WHO and OMAS scales and pain was assessed applying the Visual Analog Scale.

The sample was composed of 10 patients (8 men and 2 women) with an average age of 55.20 years. The worst manifestations of OM according WHO and OM-OMAS scale occurred after receiving a radiation dose of 22 to 60 Gy, there was an increase in BF in the first 6 weeks of RT except for the 4th week (radiation from 32 to 40 Gy) when there was a reduction of BF, and the greater pain intensity coincided with more severe OM. Conclusion lower BF was related to greater severity of OM-WHO and OM-OMAS, and BF was related to worse pain. 

Gastrointestinal mucositis (GI-M) is a debilitating side effect of mucotoxic chemotherapy that remains without effective intervention. Based on its ability to modulate multiple mediators of GI-M pathobiology, we hypothesised that serotonin (5-HT) may be an overlooked candidate for GI-M prevention/management. We therefore aimed to determine its expression in a validated, preclinical model of methotrexate (MTX)-induced GI-M and correlation with core GI-M markers.

Tumour-bearing Dark Agouti rats (N=12) received MTX (2 x 2 mg/ml i.m.) or saline, and were humanely killed at 72 hours (peak mucotoxicity). GI-M was determined based on clinical symptoms at this time point (percent change in body weight, diarrhoea grade and small intestinal wet weight). 5-HT was determined in the jejunum and colon by immunofluorescence. qPCR was used to quantify 5-HT production enzyme, Tph1, as well as 5-HT2A and 5-HT2B receptor expression.

MTX caused a decrease in jejunal 5-HT+ cells/μm^2 (P=0.0013) and relative Tph1 (P=0.0087) and 5-HT2B (P=0.0079) mRNA expression.

These key read outs positively correlated with core GI-M makers including weight loss (P=0.0005), diarrhoea (P=0.0100) and intestinal wet weight (P=0.0006).

Conclusions 5-HT is severely depleted during GI-M, suggesting a 5-HT2B-dependent anti-inflammatory mechanism consistent with documented roles in other GI disease. Promoting 5-HT production may therefore minimise GI-M and other systemic toxicities related to 5-HT depletion.

Oral cryotherapy is classified as a "recommendation (2018)" changed from a "suggestion (2013)" to prevent oral mucositis in patients undergoing autologous hematopoietic stem cell transplantation (HSCT) with melphalan conditioning in MASCC/ISOO mucositis guideline. From this background, we started cryotherapy for all HSCT patients with melphalan conditioning. We previously reported our progress of basic oral care and reduction of oral mucositis, and have been continuing intensive basic oral care. Therefore, we can evaluate the effect of cryotherapy under the condition of minimum exacerbation factors in oral hygiene. We aimed to evaluate the power of oral cryotherapy for oral mucositis in HSCT with melphalan conditioning under intensive basic oral care.

Retrospective chart review study was performed. A total of 55 HSCT patients (autologous: n=18, allogeneic: n=37) with melphalan conditioning were enrolled. Degree of oral mucositis after starting cryotherapy (n=17) was compared with those before (n=38). Statistical analysis was performed by Fisher's exact test.

The incidence of ulcerative oral mucositis (NCI-CTCAE ver 3.0, clinical exam grade > 2) was significantly decreased in the oral cryotherapy group (P=0.018), with only 5 of 17 patients (29.4%) in the cryotherapy group and 27 of 38 patients (71.1%) in the non-cryotherapy group.

Conclusions: Oral cryotherapy reduced ulcerative oral mucositis in patients undergoing HSCT with melphalan conditioning. Its effect is strong under the condition of intensive basic oral care.

Lung cancer(LC) has a high prevalence and mortality worldwide. In these patients(pts), taste and smell alterations(TSAs) are common and impactful, yet overlooked. Methods:Literature search of English language articles indexed to Pubmed&CINALH;MeSH terms: "Dysgeusia", "Olfaction Disorders", "Lung neoplasms", "Carcinoma, Non-Small-Cell Lung", "Carcinoma, Small Cell", "Adenocarcinoma of Lung", "Carcinoma,Large Cell"; non-MeSH terms "Altered Taste", "Parageusia","Smell Disorder", "Dysosmia", "Paraosmia", "Lung Cancer", "Oat Cell Carcinoma". (500ng/kg) or saline daily for 5 days prior and 2 days following an intraperitoneal injection of 5 FU (450mg/kg) or saline. Mice were humanely killed 48h post-5FU administration and intestine collected for histology and molecular analyses. We analysed histology (H&E), Ki-67 (proliferation), lipocalin (LCN)2 expression (antimicrobial peptide, innate immune response) and 16S rRNA sequencing (microbial diversity). Two-way ANOVA was used for statistical analysis.

Results 5FU reduced villous height in the duodenum and colonic crypt depth compared to saline (p<0.001). 5FU+Polara1 treatment significantly increased villous height compared to 5FU in the duodenum (p=0.043). Ki-67 positive cells decreased in 5FU treated compared to saline (p<0.0001), and increased in 5FU+Polara1 treatment compared to 5FU (p<0.0001) in the duodenum. 5FU reduced Firmicutes in colon contents in 5FU compared to saline. There was no difference in Firmicutes between 5FU+ Polara1 and saline. Polara1 significantly upregulated colonic LCN2 expression (p=0.0139).

Inhibition of vitamin D catabolism alleviates intestinal damage in 5-FUtreated mice. The mechanisms involved include maintenance of proliferation, immune and gut microbiome modulation.

Activation of toll-like receptor 4 (TLR4) is a major influence on inflammatory signalling pathway in intestinal mucositis. Pharmacological TLR4 inhibition is postulated as a new therapeutic approach. We aimed to determine if TLR4 antagonism prevents inflammation in pre-clinical experimental models of mucositis.

TLR4 inhibitors, TAK-242, IAXO-102 or vehicle control were added to T84, HT-29 and U937 cell lines and mouse colon explants before addition of LPS, SN38 and TNF-α. Supernatant was collected for human IL-8 and mouse IL-6 ELISA. Cell viability measured using XTT assay. Explant tissue was used in histopathological and RT-PCR (TLR4, MD2, CD14, MyD88, IL-6, IL-6R, CXCL2, CXCR1, CXCR2) analysis.

TAK-242 and IAXO-102 displayed no toxic side-effects at concentrations investigated, but did not provide statistically significant protection against cytostasis as measured by XTT. Quantitative histological assessment scores showed no significant differences between groups. Transcript expression of the genes was similar across groups. ELISA data is being collected and will be presented at the meeting. Conclusions TLR4 antagonism was not effective at blocking colonic inflammation in this model. Further studies using different dose and scheduling of antagonists, with rodent interventional models are needed to better understand the functional capacity of these compounds, and to decipher the complicated role of TLR4 signalling in mucositis development. 

In this study, 2 proteomics experiments were used to explore whether differences in the salivary proteome occur between patients with ulcerative oral mucositis (uOM; WHO score ≥ 2) and those without (nOM) in autologous stem cell transplant recipients. Methods Salivary proteins were analyzed using liquid chromatography and tandem mass spectrometry. TMT-labelled experiment: saliva samples of 5 uOM and 5 nOM patients were pooled at: baseline, 1, 2, 3 weeks and 3 months after ASCT. Principle component analysis was used to explore patterns between the uOM and nOM pools at different time points. Label-free quantification (LFQ) experiment: an uOM pool (consisting of saliva from 9 uOM patients and 6 time points (including 12 months after ASCT)) was generated next to a nOM pool (10 nOM patients and 6 time points). Unique and up-regulated proteins of the uOM and nOM pools were further investigated with gene ontology.

A distinct clustering of the salivary proteome of uOM pools at baseline, week 2 and week 3 after ASCT was detected. Unique and up-regulated intracellular proteins in the uOM pool were detected in the LFQ experiment, while in the nOM pool those proteins were more involved in immune system-related processes. Among the 807 identified proteins, 13.7% of the proteins were derived from the oral microbiome.

The salivary proteome was indicative of damage-related proteins in uOM patients and more protective in nOM patients. Conditioning regimens containing melphalan are associated with a high risk of mucositis in haematopoietic stem cell transplant (HSCT) recipients, proposed to be mediated by aberrant cytokine signalling. The current study aimed to a) determine the efficacy of IL-1 receptor antagonist (anakinra) in a preclinical model of melphalan(HDM)-induced mucosal barrier injury (MBI) and b) evaluate its safety in HSCT recipients. Methods Preclinical: Male Wistar rats (150-180g, N=64) were treated with HDM on day 0 (5 mg/kg, intravenously) ± Anakinra from day -1 to +4 (100 mg/kg s.c.). Primary endpoint was MBI defined by plasma citrulline. Secondary endpoints were weight loss, food intake, body temperature and the gut microbiome composition. Phase IIA: Patients with multiple myeloma undergoing high-dose melphalan were recruited and treated with anakinra (100, 200, 300mg i.v.) once daily from day -2 to +12. Primary endpoint was safety.

Anakinra minimized the intensity and duration of MBI (P=0.02) and its clinical consequences including weight loss (P=0.003) and anorexia (P=0.0001). By controlling mucosal injury, the gut microbiome was stabilized with expansion of enteric pathogens (E.coli) and fever prevented (P=0.0002). Anakinra did not cause any adverse events or dose limiting toxicities nor did it change time to neutrophil recovery in Phase IIA investigation.

Anakinra is safe in HSCT recipients and demonstrates preclinical efficacy supporting our Phase IIB multicentre, placebo-controlled, double-blinded trial to assess its clinical efficacy.

Pain, sleep disruption, cognitive deficit, fatigue, anxiety and depression frequently co-occur forming psychoneurological symptom clusters (PSCs). These symptoms tend to be brain-based and therefore we aimed to examine them via neurophenotyping.

We used neuroimaging and data-driven machine learning to classify 80 breast cancer survivors into functional neurophenotypes (i.e. neurophysiologic subgroups). We then compared psychoneurological symptoms, clinical histories and demographics between the neurophenotypes and 103 healthy female controls using pairwise ranksum tests with false discovery rate correction.

We identified 3 distinct neurophenotypes (NPs) in the breast cancer group. Each neurophenotype had a specific profile of brain network connectivity disruption (Table 1) and PSCs (Table 2 ). Additionally, NP1 had significantly more minority women and shorter time off cancer therapy (p < .03). NP2 had higher disease stage and history of radiation therapy (p < .02).

Neurophenotypes may increase our understanding regarding PSCs in breast cancer survivors. Our results identified a high-risk group (NP1) characterized by possible health disparities and high symptom burden as well as a potentially resilient group (NP2) showing moderate symptom burden despite increased disease and treatment intensity. Further study is required to determine if NP3 truly has only cognitive impairment or a tendency to under-report symptoms.

Nerve conduction studies (NCS) have been suggested as gold standard for identifying diabetic peripheral neuropathy, but their value in measuring chemotherapy-induced peripheral neuropathy (CIPN) is still debatable. Our study aimed to examine the role and added value of NCS in CIPN assessment through a secondary analysis of pooled data in relation to NCS changes observed, associations of NCS parameters with clinical and patient characteristics and quality of life, and the performance of NCS against clinical assessments. Methods Data pertaining to clinical examination, grading of CIPN, NCS, and quality of life were retrieved from five studies of cancer patients who had received taxane-or oxaliplatin-based chemotherapy. The data were grouped in cohorts of before, during or after chemotherapy, or during recovery stage, as per the time points of assessment in the original studies.

Data was available from a total of 85 cancer patients (74 females) and 162 NCS assessments. NCS results confirmed that damage of sensory nerves is more profound than motor nerves in patients at different stages of neurotoxic chemotherapy. No strong correlation was identified between NCS parameters and clinical examination outcomes or patient-reported quality of life. NCS alone was not useful in diagnosing CIPN. Conclusions NCS may not reliably measure CIPN and its impact. It has limited value in either identifying the incidence or discriminating the severity of clinically relevant CIPN. Therefore, NCS is not recommended for routine CIPN assessment in clinical oncology settings.

Chemotherapy induced peripheral neuropathy (CIPN) is among the most feared side effects to cancer treatment. In recent years, many cancer patients have taken an interest in medical cannabis and used it for selfmedication. In this study we aim to map the prevalence of CIPN symptoms and cannabis use among Danish cancer patients. To explore associated sociodemographic factors and cultural perceptions of cannabis use and collect patient use experiences.

We conducted an anonymous cross-sectional combined survey and questionnaire study in 2019. The questionnaire was comprised of 91 questions in total; 17 sociodemographic questions, 7 questions on cannabis use and the EORTC-QLQ-C30, EORTC-CIPN20 module, GAD7 and PHQ9 questionnaires. We invited all patients over the age of 18 attending ambulatory services at one of three included Departments of Oncology spanning two greater regions of Denmark and a total population of 2 mio. Results 3435 patients was invited and 2857 responded with a total response rate of 83%. 17% of patients score CIPN symptoms corresponding to a grade 1-2 on the CTCAE. 13% of Danish cancer patients use cannabis during their treatment. We will present associated data on quality of life for both cohorts. 

Radiation therapy (RT) remains crucial for treatment of glioblastoma (GBM), but cognitive dysfunction is an expected consequence of RT. In preclinical studies, the use of BMX-001, a novel metalloporphyrin with differential action in response to RT-induced stress, protected healthy CNS tissue but sensitizes RT cytotoxicity on human GBM xenografts. We sought to establish the safety of BMX-001 and evaluate cognitive function before and after RT in newly diagnosed high grade glioma patients.

We performed a phase 1 study of BMX-001 in combination with RT (6 wks total of 59.4-60 Gy) and TMZ (75 mg/m2 daily X 42 days). We administered BMX-001 as a SC injection at a loading dose before RT and TMZ and then subsequent doses 2X/wk for 8 wks. A key secondary endpoint was evaluation of cognitive function. We performed cognitive testing with computerized program CNS Vital Signs . We defined cognitive impairment at baseline as z-score ≥ 1.5 SDs below normative mean. We described improvements or declines in cognition at 2 and 6 mos from baseline.

We enrolled 15 GBM patients (age 19-80 yrs). As expected, majority of patients had cognitive impairment ranging from 46.7-80% on specific cognitive modalities. At 2 (N=15) and 6 mos (N=9), most modalities demonstrated improvement in cognitive testing.

Cognitive function is improved after RT in this GBM cohort that received BMX-001 during RT and TMZ. An open-label randomized phase II study with BMX-001 in combination with RT and TMZ versus RT and TMZ alone is currently underway.

Chemotherapy-induced peripheral neuropathy (CIPN) is a potentially chronic, debilitating condition, however no standardized assessment protocol exists. In-vivo confocal microscopy is capable of high-resolution imaging of nerves and dendritic cells in the cornea. This study investigated the association between corneal nerves and dendritic cells with CIPN severity. Methods 53 patients with CIPN treated with oxaliplatin (n=27) or paclitaxel (n=26) 3-24 months prior to assessment and 51 age-matched healthy controls were recruited cross-sectionally. The reduced Total Neuropathy Scale (TNSr) was used as an objective clinical measure of CIPN. In-vivo confocal microscopy measured corneal average nerve fiber length (ANFL) and 2 masked observers analyzed dendritic cell density (DC). Intraclass correlation coefficient (ICC) for inter-reliability and one-way ANOVA with post-hoc Bonferroni test were used, with significance set at p<0.05. Results ICC for DC was 0.99. There was loss of ANFL in the oxaliplatin (13.1 ±2.7mm/mm2) and paclitaxel groups (12.4±2.5mm/mm2) compared to controls (15.9±3.3mm/mm2, p<0.001, Fig.1 ). The oxaliplatin group had higher DC than controls (p<0.001) and the paclitaxel group (p=0.03).

Higher DC correlated with worse TNSr scores in the oxaliplatin group (r=0.52, p=0.006).

In-vivo confocal microscopy revealed corneal nerve loss and dendritic cell increase even after cessation of neurotoxic chemotherapy. Future research should assess the potential utility of corneal microstructural changes for monitoring CIPN development during treatment.

Cancer-related cognitive impairment (CRCI) is a recognised adverse consequence of cancer and its treatment that can occur in up to 75% of patients. One aim of this prospective longitudinal study of cognition in patients with newly diagnosed aggressive lymphoma, is to explore acceptability of a comprehensive, multi-faceted cognition assessment during treatment and recovery. Methods Thirty participants recruited to the longitudinal study will complete repeated measures of cognition including self-report, neuropsychological assessment, blood cell-based inflammatory markers, and brain imaging. To explore acceptability of the neuropsychological assessment and selfreport measures in a population for whom there is no reported data, the first five participants enrolled have completed a face-to-face burden interview one week after completion of the baseline assessments.

Of the five participants who have completed the burden interview, two thought components of the self-report measures were repetitive; two found an individual neuropsychological assessment difficult; one found the assessment tiring, and another felt that completion time took longer than expected. No participants suggested changes to the measures.

These findings indicate the requirement to complete a comprehensive and challenging suite of cognition assessments are acceptable to people with newly diagnosed aggressive lymphoma within the context of a clinical study.

Introduction CIPN is a prevalent and severe dose-limiting toxicity with sensory symptoms in the hands and feet. CIPN has limited biomarkers and treatments due to lack of knowledge of its pathophysiology. We studied whether CIPN involves changes in how the brain processes bodily sensations to inform novel brain-based biomarkers and treatments for CIPN.

Eleven patients rated CIPN severity (CIPN-20) and completed an fMRI scan before taxane, platinum, or bortezomib and/or 12 weeks later. The 7min fMRI task alternated 20-sec trials of attentional focus on: (1) the left fingertips (somatosensory attention) and (2) a flashing word "target" (visual attention; reference).

The 11 patients were 63±12 years old, 54% women, 54% breast cancer, yielding 16 scans (8 pre-chemotherapy). Somatosensory attention activated somatosensory cortex (S1; effect size [ES]=1.46) compared to visual attention. Patients with worse CIPN had smaller increases in S1 activation during somatosensory vs. visual attention (ES=0.38), suggesting that somatosensory attention does not activate S1 and/or S1 is chronically activated. Changes in S1 activity were not significantly explained by age, anxiety, or problems remembering (ESs < 0.12). Conclusions CIPN might be related to changes in how the brain processes bodily sensations, suggesting a target for biomarker or treatment development.

The purpose of this randomized controlled pilot trial was to determine the feasibility of yoga implementation in cancer survivors with chronic painful CIPN, and to explore the impact of yoga on CIPN. Methods Cancer survivors with chronic painful CIPN (≥ 3 months duration & ≥ 4/10 worst CIPN pain intensity) were randomized (2:1) to receive an eight-week yoga intervention (i.e., two in-person or self-guided yoga sessions per week) or usual care. Participants completed patientreported measures of CIPN and other symptoms at baseline and postintervention. Feasibility was defined as completing ≥ 12 yoga sessions. Mean changes in patient-reported measures between groups were compared using Wilcoxon rank-sum tests.

Most participants (N=44, n=28 yoga, n=16 control) were female (96%) and had stage III-IV disease (66%). Median age was 59. The yoga format was switched to virtual practice alone due to the COVID-19 pandemic after 21 participants enrolled. Overall, 19/28 (67.8%) participants completed ≥ 12 yoga sessions. Yoga group participants experienced decreases in fatigue (yoga mean Δ: -5.6, control mean Δ: -1.5, p=0.05) and depression (yoga mean Δ: -2.7, control mean Δ: 2.0, p=0.04) in comparison to control group participants, but there were no differences in CIPN pain intensity improvement (yoga mean Δ: -1.8, control mean Δ: -1.3).

Yoga was feasible for cancer survivors with chronic painful CIPN. Future research is needed to explore the impact of yoga on CIPN and other symptoms in an adequately powered randomized controlled trial.

Chemotherapy-induced peripheral neuropathy (CIPN) is an adverse effect that occurs in up to 60% of patients and can persist into survivorship. A critical barrier to the development of efficacious interventions is the lack of understanding of the mechanisms underlying CIPN. Oxidative stress, a hypothesized mechanism, regulates or mediates the HIF-1 signaling pathway (H1SP). In this study, we evaluated for gene expression and methylation associated with paclitaxel-induced peripheral neuropathy (PIPN) in survivors and pre-clinical models.

Differentially expressed genes (DEG) and differentially methylated probes (DMP) of H1SP were identified between survivors who received paclitaxel and did (n=25) and did not (n=25) develop PIPN. Candidates were evaluated as a DEG in dorsal root ganglia of mice with PIPN and DMP in T-cells and pre-frontal cortex of rats with spinal nerve injury. Results BC survivors with PIPN were significantly older; more likely to be unemployed; reported lower alcohol use; had a higher BMI, and 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. Five H1SP DEGs had at least 1 DMP (p<0.05) in survivors. One candidate gene was both a DEG in mice and had a DMP in rats.

Chronic PIPN is associated with H1SP GE and methylation in peripheral blood. Epigenetic gene regulation may play a role in the development and maintenance of PIPN. H1SP genes warrant validation and may be potential therapeutic targets. 

Cancer pharmacotherapy has improved survival rates and prolonged life by developing anticancer drugs and molecular targeted drugs. However, various adverse events have also occurred. In particular, hypoesthesia and paresthesia in the extremities of the extremities are adverse events that significantly impair daily life due to peripheral neuropathy. This time, mirogabalin is available in Japan. The effect of mirogabalin in our department was examined. Methods A retrospective study of 6 breast cancer patients who underwent cancer drug therapy from July 2019 to January 2020, were aware of peripheral neuropathy as an associated adverse event, and received mirogabalin. Verified.

The median age is 55 (35-65) . The regimens used were bevacizumab + paclitaxel in 2 cases, capecitabine alone in 1 case, capecitabine + cyclophosphamide in 1 case, docetaxel alone in 1 case and dose dense paclitaxel in 1 case. In all cases, Grade 2 improved to Grade 1 at the initial dose of 10 mg / day. In one case, the dose was eventually increased to 20 mg, and in 2 cases, the dose was increased to 30 mg. Little drowsiness has been observed as an adverse event.

Compared to pregabalin, mirogabalin takes longer to dissociate from the α2 subunit, suggesting that a more analgesic effect can be obtained. In all of the target cases, improvement of peripheral neuropathy was noticed in about 2 weeks after administration. It was suggested that pregabalin may have a rapid effect, improve quality of life, and help cancer drug therapy proceed smoothly.

Chemotherapy-induced peripheral neuropathy (CIPN) is a lasting side effect of neurotoxic treatment. The identification of optimal CIPN measures is an urgent need. This study critically evaluated current approaches to CIPN assessment. Methods 859 cancer patients (54±13 years) treated with neurotoxic chemotherapies were evaluated with patient reported outcome measures (PROMs EORTC CIPN20, FACT/GOG Ntx13), clinical grading (National Cancer Institute NCI grade, Total Neuropathy Score TNSc, nerve conduction) and sensory functional measures (monofilaments, 2-point discrimination, grating orientation, grooved pegboard). Convergent validity was assessed between measures and NCI grade as Spearman's correlation Taxanes are well known to cause chemotherapy-induced peripheral neuropathy (CIPN). To date, there are no evidence-based measures to prevent CIPN. Photobiomodulation therapy (PBMT) is based on the application of (near)-infrared light on target tissue to stimulate cell repair processes. The aim of this trial is to evaluate if PBMT can prevent CIPN and enhance the patients' quality of life (QoL). A RCT with 31 patients with breast cancer that underwent taxane treatment was performed at the Jessa Hospital (Hasselt, Belgium). Patients were randomized to receive PBM or placebo treatments (2x/week) starting at first until the last week of their chemotherapy (CT). The patients' QoL was assessed by the Functional Assessment of Cancer Therapy/Gynaecologic Oncology Group NTX scale (FACT/GOG-NTX). These measures were collected at the first CT session, 6 weeks after the initiation of CT, at the final CT session and 3 weeks after the end of CT. Mixed ANOVA revealed a significant difference in the group by time interaction for the FACT/GOG-Ntx total score (p=0.031) with a higher overall score in the PBMT group. Questions of the FACT/GOG-Ntx regarding numbness in hands and feet were analyzed separately. A significant increase in the severity of numbness in hands and feet over time was observed in the control group (ps=0.000), whereas it remained constant in the PBMT group (ps=0.072). Based on preliminary results, PBMT seems to reduce the development of CIPN resulting in a better QoL. Peripheral neuropathy (PN) is a debilitating complication among colorectal cancer (CRC) survivors. Our aim was to investigate a wide array of sociodemographic, clinical, lifestyle, and psychological factors among CRC survivors to determine their associations with PN, and thereby, to give leads for interventions. In 1,516 all-stage CRC survivors (PROFILES registry), cross-sectional data were collected on PN (EORTC QLQ-CIPN20), sociodemographic (age, sex, education, employment, partner), clinical (time since diagnosis, tumor location, stage, chemotherapy, radiotherapy, PN-related comorbidities), lifestyle (alcohol, smoking, physical activity, body mass index), psychological factors (anxiety, depression, personality) and health-related quality of life (HRQoL). After multiple imputation, correlates were analyzed with linear regressions and eliminated with backwards selection. CRC survivors (69 years; 42% female) were five years post-diagnosis, and 28-65% reported PN. PN was associated with older age, being male (sensory PN) or female (motor PN), shorter time since diagnosis, chemotherapy, osteoarthritis or rheumatoid arthritis, anxiety, depression, and worse scores on HRQoL domains, pain, nausea, vomiting, insomnia, constipation and financial problems. Sociodemographic, clinical, psychological and HRQoL factors were independently related to PN. Further research is required to examine whether adding psychological factors as targets to interventions can optimize PN outcomes and survivorship. 

This prospective study evaluated the incidence of cognitive impairment after 3 cycle DP combination chemotherapy and related risk factors.

We enrolled 23 consecutive head and neck cancer patients who received chemotherapy with DP, of which 20 patients were eligible. Baseline measures were evaluated within 2 weeks before starting the first DP chemotherapy and again within 2 weeks after the third DP chemotherapy. The protocol included a standardized neuropsychological battery and other characteristics detailed below including Mini Mental State Examination, Eastern Cooperative Oncology Group performance status, Edmonton Symptom Assessment Scale, Visual analogue scale of neuropathic pain, Beck Depression Inventory, Beck Anxiety Inventory , morphine equivalent daily dose, admission duration, main caregiver, and education level.

On baseline evaluation, all 20 patients showed normal MMSE (≥ 25). However, cognitive impairment (< 25) was found in 25% of SCCHN patients who received 3 cycle DP chemotherapy. Associated factors with chemotherapy induced cognitive impairment were age (p=0.025), education level (p=0.02), ECOG performance status (p=0.004), admission duration (p=0.0001), peripheral neuropathy (p=0.008), daily morphine dose (p=0.013), and pain score after chemotherapy (p=0.032).

These results suggest that 25% of SCCHN patients who received 3 cycle DP chemotherapy showed cognitive impairment. Associated factors were age, peripheral neuropathy, performance status, daily morphine dose, admission duration, and education level.

Chemotherapy-induced cognitive impairment (CICI) is complication of cancer treatment likely caused by neuroinflammatory-related brain changes. Whilst the presence of chronic neuroinflammation following chemotherapy has been widely accepted, the acute damage to BBB integrity has not previously been investigated. We therefore aimed to 1) develop a model of chemotherapy-induced neuroinflammation and 2) characterise the acute changes to BBB integrity that may underlie the development of neurocognitive deficits following chemotherapy. Methods Female C57Bl/6 mice were treated with 5-fluorouracil (5-FU) or vehicle and killed at 1, 2, 4, 8, 16 and 32 days following treatment (n=24). Acute changes to BBB integrity and neuroinflammatory profiles were characterised using immunohistochemical analysis of albumin extravasation and immunologic marker of glial activation, glial acidic fibrillary protein (GFAP), in the cortex, midbrain and hippocampus.

Increased BBB permeability was seen following 5-FU treatment through parenchymal and perivascular albumin staining, with minimal leakage in control animals. Elevated positive GFAP staining was observed in the CA1 region of the hippocampus at day 4 and 32 post 5-FU (p=0.0390 and p=0.0202), and in the midbrain at day 32 post 5-FU (p=0.0154).

We have shown for the first time to our knowledge, following 5-FU treatment, damage to BBB integrity and astrocytic reactivity which may underlie CICI, suggesting that the BBB is a critical mediator of CICI through facilitating the development of secondary neuroinflammatory mechanisms.

R. Sundar 1 , A. Bandla 2 , A. Leen 3 , Y.Soon 4 , R. Sundar 4 1 National University Health System, Hematology -Oncology, Singapore, Singapore 2 National University of Singapore, The N.1 Institute for Health, Singapore, Singapore 3 NUI Galway, School of Medicine, Galway, Ireland 4 National University Health System, Radiation Oncology, Singapore, Singapore 4 National University Health System, Hematology -Oncology, Singapore, Singapore

Paclitaxel-induced peripheral neuropathy (PIPN) is a disabling side-effect of paclitaxel, with few effective preventive or treatment strategies. This study aimed to determine the efficacy of current neuroprotective interventions in reducing incidence of PIPN. Methods Medical literature databases were searched from year 2000 to 2018 for published randomised controlled trials (RCTs) comparing neuroprotective interventions (either pharmacological or non-pharmacological) versus observation or placebo. Risk of bias was assessed using the Cochrane tool. Meta-analysis was performed using the random effects model. Primary outcome was incidence of PIPN. Quality of evidence was assessed using GRADE.

Of 13 relevant RCTs, 6 provided sufficient data for the meta-analysis. Pooled results from 2 RCTS of non-pharmacological interventions (244 patients) showed a 62% relative reduction of PIPN risk with low heterogeneity (RR 0.38, 95% CI 0.27-0.52, p<0.00001, I2=0%). Conversely, pooled results from 4 RCTs of pharmacological interventions (322 patients) showed a 27% relative reduction of PIPN risk with moderate heterogeneity (RR 0.73, 95% CI 0.42-1.25, p=0.25, I2=64%). The GRADE quality of the summarized evidence for both pharmacological and non-pharmacological evidence was very low. Conclusions Current non-pharmacological neuroprotective interventions may reduce risk of developing PIPN. These results pave the way towards developing therapeutic strategies with better design and outcomes to prevent PIPN.

Introduction Treatment of cancer patients with Oxaliplatin-based chemotherapy can cause different symptoms of acute and chronic peripheral neurotoxicity. Documented information about oxaliplatin-induced neuropathy (OXAIPN) in Sudan seems to be little. So, conducting such a study to estimate the incidence and management of OXAIPN will be helpful in early intervention. Methods A cross-sectional study of 121 patients treated with oxaliplatin-based combination therapy were entered during the period of January to April 2019, at Khartoum oncology hospital. The incidence of acute neurotoxicity was assessed by using a descriptive checklist for most common hyper-excitability and transient symptoms, while chronic neurotoxicity incidence was measured by EORTC QLQ-CIPN20.

Acute and chronic OXAIPN were found in 49.6% and 41.3% patients, respectively. Most of the patients who developed acute OXAIPN symptoms manifested cold-induced pharyngolaryngeal (73.3%) dysesthesias or perioral (71.7%) paresthesias. There is no significant association between the severity of chronic neurotoxicity and basic demographics. 79.1% did not inform the doctors about their complaints, and 43.5% of patients who informed doctors did not take any medication to manage OXAIPN.

Our study conclude that, most of the patients who received oxaliplatinbased chemotherapy manifested symptoms of acute OXAIPN, which may progress to chronic neurotoxicity over time.

H. Takeda 

Methods Plasma NfL and GAL-3 levels measured by ELISA were evaluated at baseline, four weeks after treatment, and progression. The change ratio of NfL and GAL-3 levels between each time point was calculated; the association with the incident or grade of CIPN was analyzed by T-test and Dunnett test.

Forty-one of 43 AGC patients (pts) were enrolled: median age, 66-y; male, 82.9%; PS 1, 48.8%; and diffuse type, 43.9%. Twenty-five pts (61.0%) had CIPN before PTX treatment. The CIPN during PTX treatment was observed in 19 pts (46.3 %); 3 pts (7.3 %) had grade > 3. The mean NfL and GAL-3 levels at baseline were significantly higher than those with healthy volunteers. Overall, the change ratio of NfL and GAL-3 levels significantly increased from four weeks to progression. When pts were classified according to the worst CIPN grade during PTX treatment, the trend of change ratio was similar in each population. The cumulative dose of PTX was also not associated with NfL and GAL-3 levels at progression or the change ratio at the progression from baseline. Conclusions NfL and GAL-3 levels in plasma increase during PTX treatment; however, they were not associated with the incidence or grade of CIPN of PTX in AGC pts previously treated with FU and platinum. Chemotherapy-induced peripheral neuropathy (CIPN) can lead to disabling symptoms and functional limitations. Patients should adopt behaviours that encourage early recognition and reporting of CIPN symptoms to ensure adequate assessment and management. This review aimed to provide descriptions of behavioural interventions (BIs) for CIPN, map behaviour change techniques (BCTs) employed and examine patient and clinician involvement in the intervention development process. Methods Literature was searched using electronic database and manual searches and screened for eligibility. Included studies were appraised using the Effective Public Health Practice Project quality assessment tool. Data were extracted using the Template for Intervention Description and Replication Tool. BCTs were examined using the Behaviour Change Taxonomy.

Six studies were included which described seven BIs. The most common BCT identified in all BIs were action planning, instruction on how to perform a behaviour and habit formation. BIs that show potential benefits on CIPN symptoms include elements that increase patient's CIPN knowledge, enhance their self-management capability and offer self-paced access to symptom management. No studies included both patients and clinicians in intervention design and development.

The review identified the most common BCTs in existing behavioural interventions and highlighted that none involved both patients and clinicians in intervention development and design. Some BIs showed positive effects on CIPN outcomes. 

To compare febrile neutropenia (FN) incidence and hospitalization among breast cancer patients on docetaxel with no granulocyte colonystimulating factors (GCSF) primary prophylaxis (PP), 4/5-day PP, or 7day PP.

We identified 3916 breast cancer patients on docetaxel-containing regimens (Table 1 ) from a hospital pharmacy dispensing database in Hong Kong in 2014-2016. Patients were offered GCSF within 5 days since administering docetaxel. Outcomes included FN incidence, time to first hospitalization, hospitalization rate, and duration.

In TC regimen, FN incidence (with odds ratio, OR) of patients with no PP, 4/5-day PP, and 7-day PP was 21.69%, 7.95% (OR 0.31, p<0.001), and 5.33% (OR 0.20, p<.001), respectively. In TJH regimen, FN incidence of patients with no PP, 4/5-day PP, and 7-day PP was 38.26%, 8.33% (OR 0.15, p<.001), and 8.57% (OR 0.15, p<.001), respectively. FN incidence of patients on AC-T regimen with no PP and 4/5-day PP was 20.93% and 6.84% respectively (OR 0.28, p=.005); with FEC-T regimen, the incidence was 9.91% and 4.77% respectively (OR 0.46, p=.035). Only 3.27% FN cases were not hospitalized. Mean (±standard deviation, SD) time to first hospitalization was 8.21±2.44 days. Mean (±SD) duration of hospitalization for patients with no PP, 4/5-day PP, and 7-day PP was 4.66±2.60, 4.37±2.85, and 5.12±2.97 days, respectively. Conclusions GCSF prophylaxis in breast cancer patients on docetaxel could reduce FN incidence and hospitalization. 4/5-day PP demonstrated similar efficacy to 7-day PP with superior saving benefits on healthcare expenditure.

Filgrastim is indicated to reduce duration of neutropenia post-autoHSCT and may be given IVPB or SQ. In one study, filgrastim SQ was associated with faster neutrophil recovery compared to IV. We aimed to compare the efficacy of filgrastim IVPB to SQ in autoHSCT patients.

This was a single-center, institutional review board-approved, retrospective cohort study. Adult lymphoma patients admitted between October 2016 and March 2019 for autoHSCT and conditioned with BEAM (carmustine, etoposide, cytarabine, melphalan) were included. Filgrastim 5 mcg/kg/day was started 5 days after stem cell infusion. Patients admitted before November 2018 received IVPB filgrastim and those admitted after received SQ due to institutional protocol change. The primary outcome was time to neutrophil count >500 cells/μL. Secondary outcomes included length of hospital stay (LOS) and antibiotic use duration. Two-tailed independent T-test was used to compare outcomes. Results 142 patients (IVPB 94, SQ 48) were included in the interim analysis. The majority of patients were male (IVPB 62%, SQ 75%) with mean age of 53 years (IVPB) and 50 years (SQ). There was no difference between IVPB and SQ groups in mean time to neutrophil count >500 cells/μL (6.3 vs. 6.3 days, p=0.9), LOS (23.5 vs. 22.7 days, p=0.2), or antibiotic use duration (9.9 vs. 11.3 days, p=0.2).

No differences in time to neutropenia resolution and neutropenia-related outcomes were observed between IVPB and SQ filgrastim administration in adult patients with lymphoma undergoing autoHSCT with BEAM chemotherapy. Introduction Antibiotic Stewardship is a key quality improvement practice. There is a paucity of real-world data describing antibiotic use in solid-tumor patients presenting to the emergency department (ED). Methods Ambulatory breast cancer patients receiving curative anthracycline/taxanebased chemotherapy at the Odette Cancer Centre (08/2013 -07/2019) presenting to the Sunnybrook ED with suspected infection, neutropenia, or fever during therapy were identified. Encounter-level data was extracted from electronic medical records and descriptively summarized.

Three hundred and thirty-nine ED encounters were identified. Seventyone percent (241/339) presented with fever, 37% (125/339) with neutropenia, and 42% (141/339) were treated as inpatients. Empiric antibiotics were ordered in 172/339 (51%) of cases; piperacillin-tazobactam (22%, 76/339), fluoroquinolones (11%, 37/339), first generation cephalosporins (11%, 36/339), aminoglycosides (11%, 36/339), and ceftriaxone (10%, 33/339) were frequently prescribed. Blood and urine cultures were obtained in 73% (246/339; 12% positivity rate) and 60% (205/359; 25% positivity rate) of cases, respectively. Drug Therapy Problems (DTPs) were identified in 61% (43/70) of reviewed cases.

Though low rates of piperacillin-tazobactam and carbapenems were found, DTPs were identified in most cases. Further research to improve antibiotic use in breast cancer patients presenting to the ED with infectious symptoms is warranted.

Colony stimulating factors (CSFs) have an established role in the prevention of chemotherapy induced neutropenia and are used as prophylaxis according to evidence-based guidelines. CSF use as a therapeutic agent in febrile neutropenia (FN) is not supported by evidence and is often based on extrapolated clinical assumptions. Methods A retrospective review on adult cancer patients, who had received parenteral chemotherapy within 90 days of presentation and admitted to a local district hospital for FN treatment between March 2018 and February 2019 was done. Fever was defined as ≥38°C, and neutropenia as neutrophils <1.0x109cells/L. The qualitative and quantitative data was analysed descriptively. Results 80 subjects were found. Empiric antimicrobial treatment was used in 100% of admissions, 45% were given therapeutic CSF, 7.5% received treatment despite having prophylaxis dosing within 14 days, 16.7% of the CSF treated group had a drop in neutrophils and delayed recovery, and 52.8% had a normal-to-elevated monocyte count on presentation. Conclusions Antimicrobial management was found to be within evidence-based recommendations. Use of CSF was found to be unwarranted at times and potentially harmful. Clear guidelines can mitigate this risk and further investigation to provide evidence is warranted. Neutrophil and monocyte correlation could be the direction to optimisation. 

Anemia is a common complication in cancer patients and may be caused by iron-deficiency. The easiest and least expensive way to manage IDA is the administration of iron salts orally; however, the feasibility of that approach has been questioned. We investigated whether the oral administration of iron to patients with AC and IDA was feasible. Methods Among patients with AC admitted to our SCU, we selected, over a oneyear period, those who presented with IDA (level of hemoglobin <11g/dl, serum iron <65μg/dl and transferrin saturation <20%).The patients received ferrous sulfate (525 mg/day) and were evaluated for compliance, adverse effects and biological response (hemoglobin and iron levels) over the following 2 weeks. Results From July 2018 until July 2019, 232 patients were admitted to the SCU. Among these, 18 (7.7%) were diagnosed with IDA, and 16 accepted to be included in the study. Only 2 out of 16 (12%) could be treated with oral iron for 2 full weeks; in the other patients, the discontinuation of iron therapy was justified by a worsening of clinical conditions (3 patients), major intolerance to oral iron (10) leading to transfusion or IV iron therapy, early discharge and loss for follow (5) or death (2) . In no patient, a significant biological response could be documented.

In this population with AC and IDA, the administration of oral iron therapy could not be successfully implemented in most patients. Other approaches such as IV iron administration with or without erythropoiesis stimulating agents should be considered. 

Therapeutics progress have turned cancer into a chronic disease and as a result, there has been a significant increase in acute onset symptoms as fever. Our objective was to study the best strategy of managing fever during cancer by general practitioner (GP) or emergency clinicians (EC). Methods Emergency department (ED) visits for fever during 6 months in 2017 in a comprehensive cancer center, were retrospectively analyzed. The appropriateness of ED referral and the possibility of an early discharge were assessed subjectively by 3 EC and 2 GPs. The concordance between the evaluators was evaluated by calculating the kappa for more than 2 evaluators proposed by Fleiss.

We identified 448 fever episodes for 396 patients, 82.8% presented a metastatic cancer; 75.3% were in a progressive disease. Fever was related to infection, neutropenia, and unknown origin in respectively 63.6%, 6.5% and 29.9% of the visits. Considering clinical criteria, ED visits were assessed as requiring hospital assessment by each EC in 88.4%; 76.8% and 68.3% (kappa 0.29 between EC ) and by GP1 and GP2 in 80.0% and 60.0% of the episodes (kappa 0.54 between EC and GP). According to patients' situation, 79% of patients were admitted. Early discharge from hospital was evaluated as possible if relayed by GP by 43.7% of the EC.

Consensus seems to emerge about specialized hospital units' management of fever that occurs during cancer. However a relay by GP allows early discharge.

The mortality rate of influenza infection can reach 10% in oncology patients (pts), and vaccination against influenza is therefore recommended in this setting. We did a cross-sectional study to evaluate influenza vaccination rate and related factors. Methods From Jan. 6th to Feb. 17th, 2020 (before the COVID-19 outbreak in Europe), consecutive outpatients receiving chemotherapy for solid tumors in our institution were included. Information on influenza shots was collected with a standardized form.

Of 569 pts receiving the form, 495 (86%) returned it (median age : 59 years (21-87)). Pts were treated for breast (44%), digestive (20%), gynecological (10%), and lung (10%) cancers. 30% had been vaccinated during the past 3 months, 3% had planned to do so, 16% were undecided and 39% refused the vaccination. Pts who received influenza shots were older than pts who did not (median: 62 vs. 58 years, p = 0.03). 21% had received a voucher from the French national health insurance agency. The vaccine had been prescribed by the treating oncologist in another 34% of cases and 21% by the family physician. Gender and tumor type had no influence on vaccination rate. The main reasons for the absence of vaccination were: lack of incitation by the treating physician (16%), fear of side-effects (18%) and concerns on vaccination efficacy (35%). Conclusions Influenza vaccination coverage was low. Efforts are needed to improve vaccination coverage in this population, starting with better communication of immunization recommendations in pts and caregivers. 

Myelosuppression is a complication reported in patients receiving certain radiopharmaceutical or extended field radiotherapy (RT) particularly if combined with chemotherapy (CTX). Neutropenic and lymphopenic patients are at risk of infection, while thrombocytopenic patients are prone to bleeding, frequently requiring interruption or dose reduction of RT-CTX treatment. IEPA is an orally administered small molecule drug, which demonstrated mitigation of hematotoxicity after CTX in clinical trials. Here we report 5 in vivo studies investigating IEPA's effect in radiation-induced myelosuppression.

Multiple administration routes and posologies of IEPA (5 to 50 mg/kg) were assessed in mouse or chinchilla rabbit models exposed to irradiation (IR) doses between 5 Gy (sublethal) and 6 Gy (LD50/30). Mortality, differential blood counts, bone marrow cellularity, and body weight were recorded for up to 45 days post-IR.

In 5 in vivo studies in IR mice and rabbits, IEPA attenuated the nadir and accelerated recovery of neutrophils, lymphocytes, and thrombocytes (Fig  1, 2) . In mice, treatment 24h post-total-body-IR resulted in increased survival (86% IEPA vs. 56% control), faster bone marrow recovery, and reduced body weight loss (Fig 3) .

Oral IEPA treatment mitigated IR-induced hematotoxicity and, under high IR up to 6 Gy, increased survival. With its good safety and tolerability profile, IEPA is a promising supportive care candidate for further investigation as a mitigator of myelosuppression caused by RT-CTX regimens and radiopharmaceuticals. 

Incidence of invasive fungal infections (IFIs) during induction therapy of acute myeloid leukemia (AML) can be reduced with antifungal prophylaxis. Invasive Aspergillosis (IA) remains an important cause of morbidity and mortality, stating the importance of using mold-active agents Methods This was a single-center, prospective, observational study which assessed AML patients undergoing induction chemotherapy and received prophylactic voriconazole between September 2019 and August 2020. The outcomes were compared with the historical data of similar patients who received fluconazole between September 2018 and August 2019 (n = 50). The dose of voriconazole was 200 mg orally twice a day Results Fifty patients with median age of 37 years (range 9-59 years) received voriconazole. Voriconazole reduced the incidence of proven/probable/ possible IFI (pppIFI) (16% vs. 38%; p = 0.023), the need to start therapeutic antifungals (34% vs. 76%; p = 0.000024) and delayed the mean time to the start of therapeutic antifungals (day 13 vs.10; p = 0.005), when compared to fluconazole. There was no statistically significant difference in mortality (24% vs 22%; p =0.81) and mortality due to IFI (0 vs 4%; p =0.48). Five patients discontinued voriconazole due to hyperbilirubinemia Conclusions Voriconazole prophylaxis is superior compared to fluconazole and can be considered in patients with AML undergoing induction therapy. Voriconazole, is more convenient to administer and an effective and cheaper alternative to posaconazole, especially in a resource-constrained setting.

A. Sahu 1 , N. Vootukuru 1 , J. Torres 1 1 Goulburn Valley Health, Oncology, Shepparton, VIC, Australia

Positive blood culture isolation in FN as per international literature is low as 19 to 25%. This study looks into the incidence of and prevalent patterns of predominant organisms in patients presenting with FN in a regional cancer service in Victoria.

This study is a retrospective analysis of the microbiologic and radiologic results of patients who presented with FN at our institution between January 1st 2015 and 31st December 2018. Results 137 patients presented with 172 episodes of FN during the study period. Blood cultures were done in 161 episodes (93.60%) with 13 (8%) positive results. E.Coli, S. Aureus and P aeruginosa was isolated in 3 (25%) each while E faecium, K oxytoca, Strep Pneumoniae and E cloacae was found in 1 (8.33%) each. PICC/PORT access was present during 42 (24.42%) episodes with cultures taken in only 22 (52.38%) with 3 positive cultures (E. Coli, S aureus and E faecium). Urine culture was done in 155 (90.12%) with a positive result suggestive of infection in 3 (1.94%). CXR was performed in 141 episodes (81.98%) with 20 (14.18%) suggestive of infection.

Our study results are in keeping with international literature revealing low likelihood of identifying infective organism in patients presenting with Introduction Short-acting Granulocyte-Colony Stimulating Factors (saGCSFs) are recommended for the primary prophylaxis of febrile neutropenia (FN) in patients (pts) receiving chemotherapy regimens at risk of FN ≥ 20%. International and national guidelines recommend a six-day or longer therapy, but in everyday clinical practice shorter therapies are often prescribed. The aim of our study is to understand if a shorter therapy has a negative clinical impact.

We reviewed all cases of pts treated at our institution with prophylactic saGCSF after chemotherapy with cisplatin, etoposide, and bleomycin (PEB) for testicular germ cell cancer or with anthracycline and ifosfamide (AI) for soft tissue sarcoma from January 2017 to December 2020. We analyzed the duration of the saGCSF therapy and the incidence of FN and its related complications in this population.

Results 93 pts were included in the analysis. 43 received PEB and 50 AI. These pts were prescribed saGCSF for a median time of 4 days (range 3-7), but the median duration of effective therapy with saGCSF was 3 days (range 1-7). The incidence of FN in this population was 5.38% (5 pts). Pts developing FN had pneumonia (1, 1.08%) or sepsis (3, 3.23%). No septic shock nor infection-related deaths were observed.

Even if there is no solid evidence from the literature, our analysis showed that a shorter duration of saGCSF prophylactic therapy might be as effective as standard therapy and has no negative impact on the incidence of FN and its complications.

The provision of clinically assisted nutrition (CAN) in patients with advanced cancer is controversial, and there is a paucity of specific guidance, and so a diversity in clinical practice. Consequently, the Palliative Care Study Group of the Multinational Association of Supportive Care in Cancer (MASCC) formed a sub-group to develop evidence-based recommendations on the use CAN in patients with advanced cancer. Methods These recommendations were developed in accordance with the MASCC Guidelines Policy. A search strategy for Medline was developed, and the Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials were explored for relevant reviews / trials respectively. The recommendations were categorised by the level of evidence, and a "category of guideline" based on the level of evidence (i.e. "recommendation", "suggestion", or "no guideline possible").

The sub-group produced 11 suggestions, and 1 recommendation (due to the paucity of evidence). The recommendations relate to assessment of patients, indications for CAN, contraindications for CAN, procedures for initiating CAN, and re-assessment of patients.

These recommendations provide a framework for the use of CAN in advanced cancer, although every patient needs individualised management. Cancer cachexia may decrease not only skeletal muscle but also cardiac muscle in humans. We aimed to explore its unfavorable impact on quantitative and qualitative cardiac parameters in patients with advanced nonsmall-cell lung cancer (NSCLC).

We retrospectively reviewed data of patients with advanced NSCLC (stage III or IV) who had planned systemic chemotherapy or radiotherapy. We measured the lumbar skeletal muscle mass index (LSMI) by CT images. We diagnosed cancer cachexia by Fearon's criteria and assessed its severity (Martin L, 2014) . We also estimated left ventricular mass (LVM, Devereux RB, 1986), Sokolow-Lyon voltage (SLV, SV1+RV5), and heart rate reserve (HRR, maximum heart rate -resting heart rate).

Among a total of 231 patients, LSMI was positively correlated with LVM, SLV, and HRR (p<0.05 each). Cachectic patients had lower LVM (138 vs 167 g, p<0.05) and SLV (2.6 vs 2.8 mV, p<0.05) than non-cachectic patients, respectively. Severe weight loss (grade 2 to 4) was associated with lower SLV (2.6 vs. 2.9 mV, p<0.05) and HRR (70 vs. 78 bpm, p<0.05) as compared to mild weight loss (grade 0 to 1).

Cancer cachexia and its severity were associated with decreased cardiac muscle mass and activity and cardiopulmonary reserve in patients with advanced NSCLC. Further study is needed to clarify the effect of cancer cachexia on clinical cardiac outcomes. 

The Quebec Cannabis Registry (QCR) was launched to evaluate the safety and effectiveness of medical cannabis (MC) through a pharmacovigilance and population-based study. We aimed to determine the effectiveness of MC to relieve cancer-related anorexia. Methods All cancer patients in the QCR with anorexia (revised Edmonton Symptom Assessment System (ESAS-r) appetite score of ≥4; 10=worst appetite) prior to starting MC, were included. Follow-up for this cohort spanned up to 6 months (2 follow-up visits). Changes in appetite scores were compared across follow-up visits, controlling for age, sex, route of administration (inhaled vs oral) and chemovars (THC-rich, THC:CBDbalanced, CBD-rich).

Eighty-one cancer patients (59.1±15.0 y, 52% female) had a mean appetite score of 6.5±2.0 at visit 1 (baseline). Half of the patients (50.6%) were prescribed oral products (cannabis oil) and 44.4% received THC:CBDbalanced chemovars. Significant improvement (p<0.0001) in appetite was found between visits 1, 2 and 3 (6.5±2.0, 3.8±3.4, 3.4±3.2) (Figure 1 ). In 74% of patients, there was a clinically significant improvement (≥1) in ESAS-r appetite score by visit 2. Inhaled and oral products, along with THC-rich and THC:CBD-balanced chemovars were associated with significant improvements in appetite (Figures 2-3) . Conclusions MC appears to be beneficial for reducing anorexia in cancer patients. This positive outcome is primarily associated with products containing THC, and is consistent with both oral and inhaled routes for MC administration.

It is unclear what evidence underpins nutritional advice received by those with advanced cancer. This scoping review summarizes current evidence for nutritional interventions (NI). Methods A systematic search included studies on NI in adults with advanced cancer excluding enteral/parenteral nutrition. Five databases (CINAHL, Embase, Medline, SCOPUS, Web of Science) were searched to 2/2021. Screening and data extraction was undertaken by two researchers. Data synthesis was narrative due to heterogeneous nature of studies. Results 1855 titles/abstracts were screened, 228 full texts reviewed, 35 studies met eligibility criteria (Figure 1 ). Of the 35 studies, 22 were randomized controlled trials (RCT), 8 prospective cohort, 4 pilot, 1 case series, 1 retrospective study. Four NI categories were identified: nutritional advice (NA), oral nutritional supplement (ONS), complementary medicine (CM), ketogenic diet (KD). The most common NI were NA+ONS (11), omega-3 fatty acids [(EPA) (3), EPA-enriched ONS (4)], and fish-oil (EPA + DHA) (4). CM and KD was examined in 7 and 3 studies, respectively. Study outcomes varied: anthropometrics, biological markers, feasibility, prognosis, quality of life, treatment tolerability. Most provided information about weight and energy intake, few reported lean body mass. Although some reported positive outcomes, evidence remains insufficient for a recommendation. Conclusions Most (62%) evidence derived from RCTs, half the NI included both NA and ONS. There is insufficient evidence to conclude the efficacy of NI in advanced cancer. 

This study is a secondary analysis of a prospective cohort study. Data on primary nutritional administration routes and data on the averaged calorie sufficiency rate/total calorie intake during the first week after admission were obtained. Subjects were divided into five age groups (18-39, 40-59, 60-74, 75-89, 90-years) . Cross-tabulation tables were made and the chisquared test was performed.

A total of 1453 patients were included. There were 21 (1.4%) and 79 (5.4%) patients in the 18-39 and 90-groups, respectively. The numbers of adolescent and young adult patients and those aged 90 years or older were very small. The proportion of patients categorized into the parenteral nutrition and hydration group was the highest in the 18-39 and 40-59 groups (52.4 and 41.1%, respectively). Among patients receiving ANH (n = 534), the proportions of patients categorized into the < 25% or < 250 kcal/day group were 18.2% in the 18-39 group and 50.0-66.4% in the other groups. The proportion of the very low-calorie group increased with age (p = 0.01).

The results showed large variations in the implementation of ANH in the different age groups and indicated that ANH was more frequently implemented in younger age groups. 

Malnutrition is highly prevalent in cancer. Malnutrition screening is recommended at all stages. Despite this, no suitable screening tool has been identified for hospice. This study sought to determine patient and dietetic researcher (DR) acceptability of three malnutrition-screening tools and to explore if they can aid appropriate hospice dietetic referrals. Methods Hospice in-patients with cancer were recruited over six weeks. Three malnutrition-screening tools were administered: Global Question (GQ), abridged patient generated subjective global assessment (abPG-SGA) and Malnutrition Universal Screening Tool (MUST). 'Ease of completion', 'usefulness in identifying nutrition concerns' and 'usefulness for identifying appropriate dietetic referrals' were rated.

Thirty consecutive hospice inpatients were recruited. The abPG-SGA was considered most difficult to complete by participants and DR. Participants found MUST and DR found GQ easiest. Ease of completion depended on cognitive effort needed, the time to complete and physical ability. abPG-SGA was rated most useful by participants and DR. Concerns on GQ and a MUST score ≥2 best identified the need for dietetic referral (81% and 78% respectively).

All participants completed the screening tools; MUST was easiest for participants and GQ considered easiest by DR. abPG-SGA was hardest (participant and DR opinion), but best identified nutrition concerns. No screening tool in isolation was adequate in identifying appropriate dietetic referrals. 

Taste and smell abnormalities (TSA) are prevalent in advanced cancer and impact nutritional status. Bad taste and altered taste/smell perception have been reported. A greater understanding of how TSA impact food intake is needed to inform nutritional interventions which are currently lacking. This study addressed this. Methods Consecutive advanced cancer inpatients were recruited. A modified 'Taste and Smell Survey' evaluated subjective TSA. Those with TSA completed a 'Food Intake Questionnaire'. Burghart Taste Strips® and "Sniffin' Sticks®" tested objective TSA. The Abridged Patient-Generated Subjective Global Assessment assessed nutritional status. Results Thirty participated. All had either subjective (25/30) or objective (27/30) TSA. None received advice about how to manage TSA. Sixteen with taste changes reported food tasted different/was tasteless. Thirteen ate less or altered food choices. Those with subjective smell changes also altered food choices (n=8) or eat less than usual (n=6). Various foods were avoided due to "no", "bad" or "altered" taste, and "bad smells". Preferred foods for taste and smell abnormalities stimulated flavour, were easier to taste and eaten in bigger volumes. Conclusions TSA were highly prevalent. Over half reported TSA affected food intake and choice. Advice about how to manage TSA was not provided. Foods avoided by some were preferred by others. Individual TSA differences and their disparate impact on food intake highlight the need for individualised care.

Providing nutritional support, administered through enteral nutrition (EN) or parenteral nutrition (PN), can counter some unwanted weight loss in cancer patients. The aim of this paper was to update the original systematic review & meta-analysis, while also assessing publication quality & effect of RCTs on the meta-conclusion over time. 

The results support the current European Society of Clinical Nutrition and Metabolism guidelines recommending enteral over parenteral nutrition, when oral nutrition is inadequate. Further studies comparing EN & PN for these critical endpoints appear unnecessary, given the lack of change in meta-conclusion and low publication bias over the past decades.

Postoperative pneumonia after esophagectomy is a significant complication and its involvement with preoperative sarcopenia, defined as low skeletal muscle mass, has been reported. Although the recent definition and diagnostic criteria for sarcopenia emphasized 5 chair-stand test (5CST), its association with postoperative pneumonia remains unclear. The aim of this study was to determine the association between 5CST and postoperative pneumonia after thoracoscopic-laparoscopic esophagectomy (TLE).

This was a retrospective, single-center, observational study of 124 men undergoing TLE for esophageal cancer between February 2018 and November 2019. 5CST is defined as the time required to stand up from a chair 5 times with arms crossed. Multivariate analysis with postoperative pneumonia as the dependent variable and 5CST, skeletal muscle mass index (SMI) and clinical information as explanatory variables was performed.

Postoperative pneumonia developed in 25 patients (20.2%). On multivariate analysis, 5CST [odds ratio (OR), 1.33; 95% confidence interval (CI), 1.06-1.68; p = 0.016], percent predicted forced expiratory volume in one second [OR, 0.94; 95% CI, 0.88-0.99; p = 0.027] and postoperative recurrent nerve paralysis [OR, 3.01; 95% CI, 1.05-8.61; p = 0.040] were significantly associated with postoperative pneumonia. There was no association between SMI and postoperative pneumonia (p = 0.146).

This study suggested that 5CST was a significant predictor of postoperative pneumonia after TLE for esophageal cancer.

Patients with advancing cancer (particularly lung cancer) frequently experience an involuntary loss of weight (especially loss of muscle mass). This is associated with a reduction in daily activities with profound effects on function and quality of life. Physical activity can improve independence and quality of life in patients with cancer but guidance for patients with cachexia are limited. The aim of this study was to co-produce homebased physical activities for patients with lung cancer and weight loss and to identify suitable outcome measures. Methods This Qualitative study included 10 semi-structured telephone interviews with a purposive sample of Healthcare Professionals and interviews with patients and carers. Data was recorded digitally, transcribed verbatim and analysed using thematic analysis.

Ten UK Health Professionals participated in telephone interviews. Using content analysis four categories and (subcategories) were identified: Physical activities (functional and adaptable, based on guidelines), Motivators/facilitators (intrinsic and extrinsic), Barriers (internal and external) and Outcome measures included assessments of 'Body systems' 'Activity' and 'Participation'). Thus far, seven patients and carers interviews have been analysed with the following themes emerging: capability, barriers, motivation and opportunities. Conclusions This study will integrate the views of Healthcare Professionals, patients and carers to coproduce home-based physical activities to optimise activity and independence in this patient group.

It was to analyze the effect of probiotic supplementation in patients with head and neck cancer. Methods Eleven male undergoing radiotherapy and chemotherapy (cisplatin) concomitant with stage 3 to 4 of HNC participated, 9 of them were eligible (48 to 85 yrs old).This pilot study was a double blind randomized control trial. Five patients were randomized in control group (CG) and 4 in the probiotic group (PG), they took skimmed powder milk without lactose and Lactobacillus Acidophilus Bifidobacterium Lactis respectively 500 g each. The supplementation started 5 days before the treatment. Repeated measure ANOVA, Mann-Whitney U test and Kruskal-Wallis (p<0.05) were calculated.

It was observed decreases in the CG for the following variables;erythrocytes (p=0.001);hemoglobin (p=0.03);platelets (p=0.018) and;hematocrit (p=0.04).Significant increments were observed in the CG for the following variables:creatinine (p=0.032);urea (p=0.008).Leukocytes, lymphocytes, calcium, glucose, aspartate amino transferase and amino transferase had no difference in both groups after probiotic consumption.

S. Morishita 1 , K. Osaki 2 , S. Takami, Y.Kimura 1 , A. Shindoh 1 , H. Murata 1 1 Niigata University of Health and Welfare, Institute for Human Movement and Medical Sciences, Niigata, Japan 2 Panasonic health insurance organization, Matsushita memorial hospital, Department of rehabilitation, Moriguchi, Japan

Patients with hematological malignancies develop severe immunity disorders and anemia, which are likely to cause a decline in the quality of life (QOL) owing to fatigue and decreased physical function. Therefore, we examined factors that influence the QOL of outpatients with hematological malignancies. Methods Thirty-two patients (18 men, 14 women) with hematological malignancies who were receiving chemotherapy and were able to undergo assessments for QOL, physical function, and fatigue were included in this study. QOL was evaluated using EuroQol 5 Dimensions, and fatigue was evaluated using Brief Fatigue Inventory (BFI). Physical function was evaluated using grip strength, knee extension strength, 6-min walking distance (6MWD), and Short Physical Performance Battery (SPPB) tests.

QOL was significantly correlated with grip strength (r = 0.42, p = 0.02), knee extension strength (r = 0.38, p = 0.03), 6MWD (r = 0.47, p < 0.01), SPPB performance (r = 0.52, p < 0.01), and BFI score (r = −0.56, p < 0.01). In multiple regression analysis, SPPB performance and BFI score were correlated with QOL.

In patients with hematological malignancies during outpatient chemotherapy, QOL may be related to decreased physical function and fatigue. SPPB performance and fatigue are factors that particularly affect the QOL. Reduction in fatigue through exercise intervention is considered to lead to QOL improvement. 

Early satiety (ES) is an under-recognised, high-impact symptom in advanced cancer. There is no agreed definition and little is known about its pathophysiology, prevalence, characteristics, and severity. No validated ES-specific assessment tool exists. This study piloted a 30-item Symptom Experience of Early Satiety (SEES) questionnaire to determine the symptom experience of those with ES. Methods Eighteen consecutive hospice patients with advanced cancer were enrolled. All completed the abridged Patient-Generated Subjective Global Assessment. Ten participants who reported ES completed the SEES questionnaire and provided feedback. Observational field notes and time to complete were gathered.

Almost all (94%) were at risk of malnutrition. The most common symptoms were dry mouth (89%), fatigue (78%) and anorexia (72%). Median time to complete was 11 minutes, 50 seconds. Three participants stated the length of time to complete was appropriate. Participants considered wording of the questionnaire appropriate (80%). Half noted some irrelevant questions. Half felt ES affected Quality of Life (QoL). Participants confused ES with anorexia, nausea and bloating. Some descriptors of ES include 'I have to rush food rather than enjoy it', 'I don't feel like having a full meal' and 'I think I have lost out on a meal'. 

Retrospective-comprehensive study of 106 colorectal cancer patients, aged 30-88 years, treated in 2019, at a regional Portuguese hospital. Nutritional status was assessed with MUST score and data from patients' process. Analysis with SPSSv25.

Mean age 66±11years, 91.6% ECOG Performance status (PS)0/1, 95.6%:stage III/IV. 26.2%: grade>/=2 diarrhea and 8.4%:grade>/=2 mucositis. The minimum Body Mass Index was 16.7kg/m2. Regarding MUST Score, patients were categorized into high(>/=2) and low risk(<2). In the high risk group (n=35), 85.7%: PS0/1, 71.4%: stage IV disease and 94.3%: unintentional weight loss. Albumin and haemoglobin were lower in this group, but nutritional evaluation was only realized in 57.1%, with 34.3% being referred to a nutritional consultation (73%diet plan+nutritional supplements).

All oncology patients should have a nutritional evaluation, but in our center this remain under-assessed. In times of significant advances, supportive therapies must be a primary concern. This study will provide an opportunity to create a protocol to screen all patients in their first evaluation and afterwards, as well the chance to verify it's impact on QoL, prognosis and survival.

Nutrition is a modifiable risk factor and a critical component in maintaining functional status and improving quality of life among patients with lung cancer. Methods Randomized control trial with a planned enrollment of 150 lung cancer patients at 4 U.S cancer centers. Eligible participants are uninsured, racial/ ethnic minorities, older adults, rural residents, or economically disadvantaged and randomized to NutriTool (control) or NutriCare (intervention) arm. NutriTool participants receive a nutrition toolkit that includes printed educational materials and monthly emails with general nutrition information and recipes. NutriCare participants receive remotelydelivered nutrition counseling by registered dietitians and homedelivered medically tailored meals prepared by the Metropolitan Area Neighborhood Nutrition Alliance. Participants will be followed for 8 months with 3 study visits conducted at baseline, 3 months, and 8 months. Data collected at study visits include AEs, QoL, malnutrition screen, and food security status.

The flexibility of this study design allowed for implementation amidst the COVID-19 pandemic due to remote consenting, enrollment, and nutritional counselling. To date, 22/150 participants have been enrolled.

This innovative study proposes a paradigm shift in the current healthcare model by introducing full integration of nutrition for vulnerable patients with lung cancer. 

Definitions and guidelines, importance of management, clinician confidence and involvement, screening and assessment tools, pharmacological and nonpharmacological interventions, psychosocial and food aspects were explored. The online survey was disseminated through Australian and New Zealand organisations (palliative care, oncology, allied health and nursing). Results 192 respondents completed the survey. 90% were medical doctors or nurses. Over 85% respondents were not aware of any guidelines, with 39% considering 10% weight loss from baseline indicative for CACS. CACS management was considered important by 77% of respondents, whilst 55% of respondents indicated that it was part of their clinical role to assess and treat cancer cachexia. In contrast, 56% were neutral or not confident about managing CACS, and 93% believed formal training in CACS would benefit their clinical practice. Formal nutrition screening tools were generally not used (79%) however 75% screened for specific symptoms. Antiemetics (80%) and nutritional counselling (86%) were most prescribed or recommended, respectively.

This study exemplifies the urgency for training and a structured CACS management plan for HCPs.

Personalised nutrition can improve cancer prevention and decrease cancer treatment side effects and risk of relapse. This study aims to identify the needs and expectations regarding "nutrition and cancer" information, among cancer and cancer-free individuals. Methods We performed a cross-sectional online anonymous survey, shared on cancer social networks, emailed to high cancer risk patients followed at a French single cancer centre or handed on flyers to cancer patients during their visit at the cancer centre. Results 2886 individuals answered the survey between June, 5th and July, 8th 2020. One third had a cancer history (n=918), 13% had a genetic cancer predisposition (n=374), and 55% belonged to the general population (n=1594). Around 90% of participants were women and more than 2/3 had a college degree. Cancer patients were older than cancer-free participants (p<0.0001) (table 1). About 70% of participants considered that they lacked information about "nutrition and cancer". Only 12% of cancer patients considered they had received enough information on nutrition during their care pathway, 62% of them wished they had received this information at the beginning of their treatment, and 54.8% throughout the oncological care pathway. Specific needs and interests about nutritional topics are described in table 1. All proposed topics were considered as important by more than 3/4 of the participants.

Despite advances in defining CAC, challenges in early diagnosis and lack of standard of care guidance remain, contributing to suboptimal interventionmissing the critical period for curtailing CAC. Methods Expert opinion on CAC prevalence, risk factors, diagnosis and management were gathered using Delphi methodology. In an initial survey, 8 medical oncologists from 4 countries were invited to complete an offline questionnaire on their insights based on relevant published literature.

For cancers of high/very high CAC risk, respondents recognized that CAC prevalence in their practice were variable but consistent with published rates (Anker 2019) while for low/middle risk, estimates were lower. Certain anticancer therapies and comorbidities may worsen CAC. Most respondents agreed with definitions proposed by Fearon 2011 and found staging scores (eg CASCO Argiles 2017; CSS Zhou 2018) clinically useful. Besides weight and BMI, few biomarkers (albumin, hemoglobin) are commonly monitored to identify pre-CAC/CAC. Early satiety, sarcopenia and weight loss concern were triggers for pharmacological intervention in at-risk patients; weight improvement, poor response, intolerability or end-stage disease were cited as reasons to stop treatment.

Respondents broadly agreed with current definitions of pre-CAC and CAC and favored proactive management of pre-CAC. A follow-on survey to identify areas of consensus in CAC/pre-CAC assessment and management is ongoing. 

Breast cancer patients frequently develop radiation dermatitis (RD) when undergoing post-operative radiation therapy (RT). Traditional RD assessment methods measure clinician-reported outcomes (CROs), but patient-reported outcomes (PROs) have gained recent popularity. The purpose of this prospective analysis was to compare PROs with CROs of breast RD. Methods Demographic and treatment characteristics were collected for patients receiving post-operative RT between February 2018 to September 2020. Patients and clinicians completed a skin symptom assessment at baseline, weekly during RT, and at a one-to three-month follow-up visit. Skin treatments used by patients were collected. Concordance between each PRO and CRO was determined using percent concordance and concordance index (C-statistic) by logistic regression analysis. Results A total of 777 patients were included (Table 1 ). All skin symptom assessment items were significantly underreported by clinicians in comparison to patients (p<0.0001), with a low to moderate level of concordance (Cstatistic range: 0.58-0.70; % concordance range: 29%-50%) ( Table 2) . Patients and clinicians, however, identified similar symptom trajectories over time (Figure 1 ).

There were significant discrepancies between PROs and CROs when assessing breast RD. The study findings highlight the need for improved RD symptom assessment and support the development of a new tool with both patient and clinician components.

Nowadays, oncological patients live also many years after the end of oncological treatment, and this permit to observe a new spectrum of cutaneous side-effects: late effects. Skin alterations could represent the first sign of many of these late effects. Methods Vascular involvement is an emerging aspect because of the damage of different vascular structures. Chemotherapy induced peripheral neuropathy (CIPN) is also frequent, clinical features are various and it affects quality of life. Endocrine involvement includes: hypopituitarism, thyroid dysfunction, adrenalitis and adrenal insufficiency. Also gonads could be damaged.

Capillaroscopy could be used in order to diagnose initial vascular injury. CIPN could be often revealed by skin and skin appendages atrophy and dystrophy. Endocrine changes could be associated to many skin and skin appendages signs: hypo-or hiper-pigmentation, hair and nails alterations, necrobiosis lipoidica, telangiectasias and subcutaneous modifications, in particular in fat composition and architecture. Conclusions Close follow-up and adoption of early risk-reduction strategies could potentially reduce the impact of these sequelae. Skin surveillance could be a great tool for early diagnosis.

This study investigated the occurrence of skin toxicities and skin-related quality of life (QoL) levels in lung cancer patients taking oral targeted agents.

This cross-sectional study enrolled 152 lung cancer patients receiving treatment via oral targeted agents. We measured the skin toxicities including rash, hives, acne, nail ulceration, nail ridging, nail discoloration, stretch marks, sensitivity to sunlight, skin dryness, itching, hair loss, and skin darkening using the Patient-reported outcome Common Terminology Criteria for Adverse Events (PRO-CTCAE) and skin-related QoL was determined using the Dermatology Life Quality Index. These collected data were then analyzed using descriptive statistics.

The level of skin toxicities was highest at 2.07 ± 1.20 (out of 4) for skin dryness followed by itching 1.91 ± 1.25, rash 1.46 ± 1.32 , skin darkening 1.39 ± 1.16 , hives 1.38 ± 1.26 , acne rashes 1.37 ± 1.26. The mean skin-related QoL of the study participants was 7.29±6.11 out of 30. More than half of the patients were affected by their quality of life with moderate or higher levels. The skin-related quality of life showed significant differences according to the presence or absence of all skin toxicities. Conclusions Close attention must be paid to the skin toxicity levels in lung cancer patients receiving oral targeted agents and interventions must be developed to improve the skin-related QoL in these cases 

Hand-Foot Skin Reaction (HFSR) is associated with multi-targeted tyrosine kinase inhibitors that target vascular endothelial growth factor receptor (VEGFR). HFSR involves the palms and soles (edema, erythema, hyperkeratosis, and bullae) and adversely affects patients' quality-of-life and consistent therapy dosing. The incidence of HFSR differs among VEGFRi, 5-60% (all grades)/1-18% (grade 3). To date, no FDA-approved treatment is available, and only marginal benefit has been shown with topical urea or steroids. The pathogenesis of HFSR is associated with impaired vascular repair mechanisms caused by inhibition of VEGF signaling. We hypothesized that stimulation of VEGFR through OQL011 topical ointment will mitigate HFSR symptoms. Methods NCT04088318 is a Ph 2, DB, RCT to evaluate safety/efficacy of OQL011 vs. vehicle for HFSR from VEGFRi therapy. 112 pts in 2 parts. Part 1, 42 pts will receive OQL011/vehicle (2:1) TID for 6 wks. The PE is improvement of NCI CTCAE v5.0 for palmarplantar erythrodysesthesia (PPE) to grade ≤1 by wk 3 (Part 2, 70 pts randomized into 2 additional doses/vehicle (2:2:1)). In addition, an investigator global assessment (IGA) for HFSR a new tool is being used in this trial to specifically assess skin recovery. The validity of IGA criteria will be evaluated by assessing the interrater and intra-rater reliability. The correlation between IGA, NCI CTCAE v5.0 for PPE, and patient-reported outcomes including Visual Analog Scale of Pain, Hand-foot Quality of Life questionnaire will also be evaluated. This study is actively enrolling.

Chemotherapy-induced alopecia is an adverse effect that impacts on selfimage and quality of life. Scalp cooling has been used as a strategy to prevent alopecia. This study was aimed to describe the effect of scalp cooling on preventing chemotherapy-induced alopecia and to estimate the adverse effects related to the intervention. Methods Longitudinal, descriptive study performed in a chemotherapy outpatient unit. Data were obtained from the electronic medical record of patients who received scalp cooling between January 2016 and February 2020. Grade 0 or 1 of alopecia according to the Common Terminology Criteria for Adverse Events, version 4.0, was considered successful in preventing alopecia. Adverse effects such as pain, headache, cold intolerance, and dizziness were measured. Descriptive analysis was performed for all variables. Results 199 female patients (mean age = 54 years) were included, most with breast cancer. After a mean of 8.24 scalp cooling sessions, prevention of alopecia was observed in 184 (92.5%) patients, in which 66 received chemotherapy protocol with anthracyclines and 118 without anthracyclines (p = 0.004). Scalp pain 8-10 was reported by 26% of patients after 10 minutes of cooling and by 24% after 30 minutes. Cold intolerance was the second most frequent adverse effect (23.1%) ( Table 1) .

Scalp cooling was effective in preventing alopecia, considering that most patients had less than 50% of hair loss. Protocols for pain control and monitoring of cold intolerance should be performed to improve tolerance to the intervention. 

Patients report a high psychosocial impact of radiotherapy-induced alopecia (RiA). A 75% to 100% of radiotherapy (RT) recipients have noticeable hair loss of the scalp at single-fraction RT doses greater than 2 Gy. We reported the literature on RiA, including its prevention and management. Methods A systematic review was conducted through OVID Medline and Embase databases between 1970 February 2021, following PRISMA flowchart ( Figure 1 ). All studies in the English language that evaluated RiA were included. Results A total of 16 articles were identified for inclusion (Table 1) . Most studies included were retrospective case series (69%) and focused on dosimetric assessment. Two-dimensional (2D) and threedimensional (3D) conformal RT techniques combined were the most frequent (37.5%). A hypofractionation schedule was adopted in most studies (44%), with a median value of total RT dose of 36 Gy and a mean scalp dose of 25 Gy. Prevention was only successful by adjusting RT methods and management included psychological and physical interventions.

Research on RiA remains worthwhile since it's prevention could improve quality of life, but findings on current approaches to prevent and manage RiA remain controversial and are mainly based on retrospective studies.

Still today, there is an unmet need to define the most appropriate interventions for preventing and managing acute radiation dermatitis (RD). Potentially, radiotherapy (RT) and local/systemic therapy may represent confounding factors. Based on a systematic review on RD, we aimed to provide an insight on these features.

In order to update the 2013 MASCC clinical practice guidelines on RD, a systematic review of the literature on RT features (technique, fractionation and total dose) and concurrent local/systemic therapy were collected across studies.

Out of a total of 287 retrieved articles focused on interventions for RD, detailed information on RT features were present in 197 of them (69%) ( Table 1) . Two-dimensional (2D) and threedimensional conformal (3D CRT) techniques combined were the most frequent (77%). Conventional fractionation was adopted in most studies (81%), with a median value of total RT dose of 57 Gray. Information about local/systemic therapy were present in 138 articles (48%): concurrent chemotherapy (49%) was more common that hormone therapy (22%).

The prevalence of outdated RT techniques and high total dose in the included studies may lend support to the strength of interventions on RD prevention and management. A smaller impact can be hypothesized from the use of concurrent local/systemic therapy.

Acute radiation dermatitis (RD) is a common side effect of radiotherapy that may poorly impact patients quality of life and interrupt treatment in severe cases. We report the results of a literature review on RD prevention and management. Methods A literature search was conducted through OVID Medline, Embase, and Cochrane Central Register of Controlled Trials databases between 1980 and September 2020 ( Figure 1 ). All studies in the English language that evaluated a skin therapy for the care of acute RD were included. The studies were selected if the intervention aimed at either prevention (administered prior to onset of RD) or management (administered to mitigate the symptoms of RD). Relevant information, such as the study type, disease site, and radiotherapy features, were collected across studies. Results A total of 287 articles were identified for inclusion, and original studies were categorized by treatment type ( Table 1) . The majority of studies included were randomized controlled trials (52.6%). The assessment of quality and level of evidence has been graded according to the criteria listed in Table 2 .

The results will be presented to the MASCC clinical practice guideline working group through a Delphi consensus survey and finalised in May 2021 to consecutively update the 2013 RD guidelines. Finalized recommendations will be presented at the 2021 MASCC conference.

DRESS syndrome is a rare drug-induced hypersensitivity syndrome, reported in less than 1/1000 patients treated with vemurafenib.

To report a case of a metastatic melanoma patient treated with vemurafenib who developed DRESS syndrome. Diagnosis of DRESS syndrome was made by using The Registry of Severe Cutaneous Adverse Reaction (RegiSCAR) score. Treatment was provided in collaboration with dermatologists and according to available literature data.

Symptoms and signs were developed approximately 6 weeks after starting vemurafenib, with a fever, diffuse maculopapular erythematous rash (Image), generalized lymphadenopathy and fatigue. Investigations showed aspartate aminotransferase and alanine aminotransferase levels > 2.5 ULN, and alkaline phosphatase and gamma-glutamyl transferase > 10 ULN, respectively. Eosinophil count was highly elevated with 16000/mmc. A diagnosis of DRESS syndrome was established based on a RegiSCAR total score of 6. Treatment included: parenteral and local corticosteroids and skin care. DRESS was responsive to therapy and patient was discharged on oral corticosteroids with dose-tapering. In the literature vemurafenib-related DRESS syndrome is described in case reports, trials and post marketing follow-ups. Conclusions DRESS syndrome has been reported rarely with vemurafenib use. The therapy of DRESS syndrome is not completely defined as such treatments have not yet been evaluated in clinical trials.

E. Erkan 1 , K. Pilanci 2 , S. Suekinci 3 , F. Aydogan 4 Introduction Approximately 17% of women with breast cancer are diagnosed before the age of 40 in Turkey. Women with breast cancer in their 20s or 30s face unique challenges that impact their quality of life. Chemotherapy-induced hair loss is one of the most alarming outcomes for oncological patients and is underestimated by physicians. The main purpose of this study was to investigate how patients handled chemotherapy-induced hair loss.

We conducted a verbal survey to determine what they are doing to patients for hair, eyebrows, eyelashes loss. The data obtained in this study was provided by 23 patients comprised of young women under age 40 with breast cancer who underwent chemotherapy.

To cope with hair loss, 12 patients stated that they used wigs; all 23 patients participating in the study reported that they used bandanas/ scarves or hats. Three patients verbalized that they had undergone micro-pigmentation procedures before the diagnosis of the disease. Eight patients confirmed that they drew their eyebrows using a pencil. 2 patients use artificial eyelashes. None of the patients had consulted a dermatologist for professional advice.

Our results showed that patients did not receive adequate medical support for hair loss. Our institution has started a special wellness program, including dermato-cosmetic support for women with breast cancer at a young age. Comprehensive communication between the surgical/ medical oncologists and the patients as well as the dermatologists would help women cope with this side effect and improve their quality of life. 

Radiation dermatitis (RD) is a common side effect of radiotherapy. Many different treatment strategies are currently used to address RD, but there is a lack of consensus and RD prophylaxis and management guidelines are largely unchanged in the last ten years. This review compared RD consensus guidelines published in the last ten years by several organizations: Multinational Association for Supportive Care in Cancer (MASCC), British Columbia Cancer Agency (BC Cancer), Cancer Care Manitoba (CCMB), Oncology Nursing Society (ONS), and Society and College of Radiographers (SCoR).

Areas of agreement and discordance were assessed among the MASCC, BC Cancer, CCMB, ONS, and SCoR guidelines (Table 1) .

Treatment recommendations are listed in Table 2 . The strongest agreement among the guidelines exists for the use of topical corticosteroids and standard skin care. All guidelines recommended washing with water and soap and the use of topical corticosteroids, but SCoR only supports prophylactic corticosteroid use for individuals deemed at high risk of developing RD. There is minimal consensus on an optimal dressing or barrier film product for RD prophylaxis or management. MASCC makes a weak recommendation for the prophylactic use of silver sulfadiazine to reduce RD, while BC Cancer, CCMB, and SCoR recommend its use upon signs of infection.

Further research is recommended in order to establish optimal treatments for RD prophylaxis and management and minimize discordance among guidelines.

Chronic radiation-induced skin effects are a late adverse reaction that occurs in months to years post radiotherapy for cancer treatment. These skin effects can significantly reduce patient's quality of life and can include fibrosis, telangiectasias, ulceration, and necrosis. The purpose of this review is to gather evidence on the prevention and management of these chronic skin effects. Methods A literature search was conducted through OVID Medline, Embase, and Cochrane looking at studies published between 1980 and September 2020. Studies were included in the analysis if they assessed the use of a skin treatment for radiation-induced skin toxicities at least 90 days post treatment. All cancer sites were included.

This review found two randomized controlled trials on the prevention and nine non-randomized studies on the management of chronic radiationinduced skin effects (Figure 1 ). Prevention strategies were generally effective and included pentoxifylline as well as laser therapy. Management strategies showed mixed results with hyperbaric oxygen, laser therapy, and combined pentoxifylline and tocopherol showing effectiveness (Table 1) .

The existing literature on the prevention and management of chronic radiation-induced skin effects is limited. The results of this review will be presented to working group members through a Delphi consensus survey and recommendations will be included in the 2021 radiation dermatitis skin care guidelines. Introduction Steroid-refractory Graft-Versus-host disease (GVHD) is common after allogeneic hematopoietic cell transplantation (HCT). Nutritional deficiency may occur as a complication due to factors including decreased dietary intake, medications, metabolic requirements, and gastrointestinal GVHD. Cutaneous eruptions due to nutritional deficiency can mimic cutaneous GVHD. Examination of nutritional status may identify an easily treatable intervention for refractory dermatitis. Methods 35 consecutive patients (24 male; 11 female) at Stanford Hospital and Clinics between January 2019 to December 2019 were referred to dermatology clinic for refractory dermatitis after allogeneic HCT. Bloodwork for 12 micronutrients were checked (vitamin A, B1, B2, B3, B6, B9, B12, C, iron, protein, zinc, selenium). Results 74.3% of all patients had deficiency in more than one micronutrient. Most common deficiencies were vitamin B6 (73% of patients), zinc (46.2%), vitamin C (38.5%), protein (26.9%), vitamin A (23%), iron (23%). Clinical improvement in skin dermatitis occurred within 3 days to 8 weeks with over the counter supplementation. Conclusions Mixed nutritional deficiency is common and underrecognized after allogeneic HCT, and can present with cutaneous manifestations that mimic refractory cutaneous GVHD. In cases of suspected GVHD with poor response to standard treatment, recognition and treatment of nutritional deficiencies may lead to improvement. Disclosures of Interest: non declared. 

Radiation dermatitis (RD) is a side effect experienced by many patients undergoing radiotherapy (RT) for breast cancer. The purpose of the present study is to determine the association between RT-induced skin outcomes and items on the Edmonton Symptom Assessment System (ESAS), a validated patient-reported symptom screening tool. Methods Patient and treatment characteristics were collected retrospectively for breast cancer patients treated with adjuvant RT between December 2013 and November 2015. Prospective data was collected through clinician-reported surveys. Linear regression analyses were performed to detect the relationship between patient-reported ESAS scores and clinician-reported RD symptoms. Results A total of 857 patients were included in the analysis. Moderate to severe scores were commonly reported for fatigue (n=412, 48%), wellbeing (n=386, 45%) and anxiety (n=266, 31%) ( Table 1) . No RD symptoms were found to be significantly associated with any ESAS items (Table 2) .

The ESAS accurately reflects symptoms of fatigue, anxiety, and wellbeing for breast cancer patients undergoing RT. Our study, however, found no association between ESAS scores and RD severity, which may reflect the shortcomings of the ESAS. Further research is necessary to warrant the development of a new site-specific symptom screening tool for use in RT for breast cancer.

Radiation dermatitis occurs in 90% of patients undergoing radiation therapy (RT). Currently, there are no predictive markers for these skin reactions. This study examined 10 inflammatory analytes as novel indicators of maximum radiation dermatitis severity. Methods Multi-analyte flow cytometry measured plasma levels of IL1α IL1β, IL1RA, IL6, IL12, IL17A, IFNγ, IP10, TNF, and TNFα in 175 female breast cancer patients (mean age 58) from a previously completed multicenter, phase 2 RCT examining the prophylactic effectiveness of topical agents for radiation dermatitis. The trial was conducted at 5 U.S. community oncology practices in NCORP. Radiation dermatitis severity (RDS) was measured using RDS score ranging from 0 to 4 with 0.5 increments. Plasma was collected at: baseline (i.e., before RT), week 3 of RT, and end of RT. All statistical analyses were performed at significance level 0.05 using JMP Pro 14.1.

Standard least squares regression showed that baseline IP-10 levels were predictive of maximum RDS (RSME=0.700, p=0.003). Similarly, IP10 levels at week 3 were predictive of maximum RDS during RT (RSME=0.702, p=0.004).

These findings suggest that IP10 could serve as a predictive blood biomarker for maximum radiation dermatitis severity in breast cancer patients. Further research is needed to confirm these findings. S u p p o r t : N C I 1 R 2 1 C A 1 7 8 6 4 8 -0 1 A 1 a n d N C I N C O R P UG1CA189961." 

Immune checkpoint inhibitors (ICIs) can exacerbate pre-existing psoriasis and induce de novo psoriasis. In the absence of specific guidelines for managing this ICI-mediated skin toxicity, we summarize all existing evidence on the treatment of ICI-mediated psoriasis.

We queried the MEDLINE/Embase databases for all articles with an ICI and psoriasis-relevant term in the title or abstract. For included articles, patient and cancer history, psoriasis phenotypes, treatments, and treatment efficacy were collected. Consensus was achieved for all data.

Amongst 242 patients from 60 publications, treatments received included topical steroid monotherapy (54.1%); systemic steroids (SS, 17.1%); methotrexate (14.0%); acitretin (19.0%); apremilast (6.3%); phototherapy (PT, 9.8%); and biologics (n=9, 4.4%). Complete (CR) or partial response (PR) occurred often (87.3%) but varied widely (CR range: 10.0% PT -42.9% SS). Topical monotherapy had frequent response (86.9%) and rarely caused ICI discontinuation (12.9%). Biologics targeting TNF-alpha, IL-17A, IL-12/23, and IL-23 had mixed efficacy (CR 1/9, PR 6/9, NR 2/9) with frequent ICI discontinuation (4/9, 57.1%). Evidence had low quality scores with high risk of bias. Conclusions Diverse treatments have been reported for ICI-mediated psoriasis, with varying efficacy and impacts on ICI regimens. These data can support the future development of expert consensus guidelines for the treatment of ICI-mediated psoriasis.

Immune checkpoint inhibitor-induced bullous pemphigoid (ICI-BP) is a rare dermatologic toxicity that causes significant morbidity and can necessitate ICI discontinuation. Diverse treatments are used for ICI-BP, including systemic steroids (SS) and biologics; however, the impact of these treatments on the ICI-mediated anti-tumor response is unknown.

We identified all cases of ICI-BP at our institutions, confirmed by consensus amongst three dermatologists. Patients were stratified into three treatment groups: SS and biologics (SSB), SS without biologics, and non-SS/non-biologics therapy (NST). Overall survival (OS), time to progression (TTP), and progression-free survival (PFS) were calculated from ICI-BP onset to December 31, 2020 or death. An inverse probability weighting regression controlled for age, mucosal disease, CTCAE grade, ECOG status, and cancer stage. Results 35 ICI-BP cases (80% CTCAE grade 2+; mean 13.7 cycles to ICI-BP) were subdivided into SSB (n=11), SS (n=15), and NST (n=9). When adjusted for ICI cycles, preliminary OS analysis trended toward the SSB cohort having a reduced hazard of death (0.07 vs SS; 0.70 vs NST, p=0.06). The SSB cohort trended toward a reduced hazard of PFS (0.24 vs SS; 0.08 vs NST, p=0.12). No relationship was found between treatment and TTP (p=0.68). Conclusion Steroid-sparing biologics (i.e. dupilumab, omalizumab, rituximab) can be used to treat ICI-BP to avoid SS therapy without negatively impacting cancer outcomes. The sign of Leser-Trelat is a rare paraneoplastic cutaneous condition defined as sudden onset of multiple seborrheic keratoses in the setting of an underlying malignancy. It is well documented in gastrointestinal adenocarcinomas and T-cell lymphomas. Cytokines and growth factors produced by cancer are thought to induce the rapid eruption of seborrheic keratoses. A literature review for 'Leser-Trelat' and 'nodular sclerosis Hodgkin lymphoma' (NSHL), revealed no previous reported cases of this disorder associated with NSHL. We are reporting the case of a 72-year-old man with treatment naïve NSHL, presenting to the hospital with hematuria complicated with blood clots and multiple seborrheic keratoses covering his back. The seborrheic keratoses were monitored daily with photos and he was started on intravenous fluids (IVF) and continuous bladder irrigation (CBI). The patient's last visit with his dermatologist was five months prior to this hospitalization, before his diagnosis of NSHL, and did not reveal an impressive quantity of seborrheic keratoses. Intravenous fluids and CBI seemed to decrease the number of seborrheic keratoses, to the point that the seborrheic keratoses nearly resolved except for a few larger and more chronic lesions. We are hypothesizing that IVF and CBI have a dilutional effect on the cytokines and growth factors released from tumor cells. Patients who are bothered by the itchy symptoms or cosmetic looks of seborrheic keratoses can be offered this non-invasive treatment while they await definitive chemotherapy treatment.`O

In the Netherlands scalp cooling has started in 1996 and is now available in almost each hospital. Information provision and the use of scalp cooling differs broadly between centers. The goal of this study was to explore the patients choice for scalp cooling. Methods Patients with solid tumors and a chance for severe alopecia completed a newly developed questionnaire during chemotherapy or in follow up.

We included 66 patients in 4 hospitals, of whom 12 (18%) choose for scalp cooling and 14 (21%) had already finished chemotherapy. Thirty-two patients (49%) reported not to have been informed about scalp cooling and 18 patients (27%) knew about scalp cooling before cancer diagnosis. Among patients who were informed, 5 patients (14%) reported the information to be unclear and 24 (71%) thought to have received sufficient information to make their decision. Patients who chose scalp cooling reported equal importance of hair compared to patients without scalp cooling. Most important reasons for not choosing scalp cooling were: not offered (33%) and hair loss not a major problem (24%). Patients who decided to use scalp cooling reported as most important reasons: for myself (42%) and for myself and my significant others (25%). Only 2 patients regretted their choice and both had no scalp cooling.

Despite extensive experience with scalp cooling in the Netherlands, there is still need for improvement of information in Dutch hospitals in order to give each patient a chance to decide him/herself about receiving this supportive care. 

Radiation-related caries is one of the major long-term side effects in the oral cavity related to head and neck radiotherapy (HNR). The impact of HNR on microbial changes and mineralized dental tissues remains poorly understood to explain the clinical aspect and progression of radiation-related caries. As dental caries is a biofilm-dependent disease, it is important to analyse the microbiota changes through bacterial genomic next-generation sequencing. Therefore, this research aimed to characterize the microbiota of oral mucosa (OM), dental biofilm (DB), radiation-related caries (RRC) and gingival crevicular fluid (GCF) of head and neck cancer patients. Methods 49 individuals were divided into 3 groups: C/C: control patients with dental caries; RT: irradiated patients without caries; RT/RRC: irradiated patients with radiation-related caries. All the samples were collected and

Xerostomia is one of the most common side effects of radiation therapy in head and neck cancer patients. However, there is a scarcity of pharmacological agents that can effectively prevent radiation-induced xerostomia. The present study aims to compare two simple physical methods, namely sour taste of chewable ascorbic acid tablets and mechanical stimulation by chewing gums for the prevention of radiation-induced xerostomia.

This was a prospective, randomized, controlled, open label trial conducted on the head and neck cancer patients receiving radiotherapy. Salivary secretion and observer-rated xerostomia scores were evaluated at five different time intervals till the end of radiation treatment. Quality of life was assessed by QLQ-H&N35 score.

Total 37 patients were analysed. Salivary function was similar among both groups at baseline. Hyposalivation was effectively prevented by both the agents. Salivary flow was significantly higher (p, 0.01) at the end of radiation in the ascorbic acid group (unstimulated 0.40gm/min, stimulated 0.88gm/min) compared to the chewing gum group (unstimulated 0.32gm/ min, stimulated 0.77gm/nmin). Percent decrease of flow over the baseline was less with ascorbic acid (16.67% vs. 31.91%).

Chewable ascorbic acid and chewing gum may effectively prevent radiation-induced xerostomia. However, Chewable ascorbic acid was more effective in this regard and resulted in better QoL. 

Limited evidence exists to guide pre-radiation therapy (RT) dental care which is thought to minimize long-term sequelae following RT for head and neck cancer (HNC). We utilized a Modified Delphi technique to develop consensus guidelines for dental care in HNC patients undergoing RT.

Canadian dental oncologists were invited as panelists. From March to December 2020, three rounds of iterative surveys and a virtual meeting were completed with questions based on six domains including radiation dose and treatment recommendations for teeth with various dental conditions. Questions were stratified by patients at low to high-risk of post-RT complications and by tooth position and location. A 70% response rate and 75% consensus level were set for each round. Questions not reaching consensus were moved to subsequent rounds.

Of 44 invited panelists, 32 completed round one and 18 attended the virtual meeting (response rate >70% between rounds). The radiation threshold at which all panelists would extract teeth to prevent osteoradionecrosis was 70Gy in the maxilla and 60Gy in the mandible. Panelists opted to extract teeth in high-risk patients, or when teeth were located in the mandible or posterior regions. Results were used to develop five pathways: initial treatment and pathways for teeth in the posterior and anterior maxilla or mandible.

The guidelines established here will be tested prospectively in a multi-centre study and represent an important first step towards establishing evidence-based dental treatment pathways for HNC patients.

A. Almståhl 1 , C. Karlsson 2 , J. Skoogh Andersson 3 1 Institute of Odontology, Dept of Oral Microbiology and Immunology, Gothenburg, Sweden 2 Jönköping University, Odontology, Jönköping, Sweden 3 Institute of Odontology, Dept of Periodontology, Gothenburg, Sweden Objective To evaluate the effect of an oral care programme for patients undergoing treatment for cancer in the head and neck region regarding mucositis.

Patients scheduled to undergo curative treatment for head and neck cancer are included in 5 regions in Sweden. All patients are advised to clean their teeth twice a day and to avoid smoking and alcohol. The patients are randomized to an intervention group or to a control group. Patients in the intervention group rinse with a sodium chloride/bicarbonate solution 5 times/day and record their oral hygiene measures and rinses in a diary. They visit the dental hygienist once a week for professional oral care and get a reinstruction in oral hygiene if needed. Patients in the control group follow ordinary routines (visit the dental hygienist once a week for professional oral care). Mucositis is scored using the Oral mucositis assessment scale (OMAS). Results 40 patients (26 men, 14 women) have completed the study so far. The most common diagnosis was tonsil cancer (n=20) and the most common treatment modality RT+chemotherapy (n=20). Preliminary results show a tendency to lower mean scores for ulceration week 2-6 during RT in the Intervention group (n=20) compared with the Control group (n=20). Conclusions A lower degree of ulceration during treatment might decrease oral pain which in turn is positive for the patient's ability to eat, drink and perform oral hygiene. Introduction Jaw osteonecrosis (JO) is a rare but complicated condition that can occur during biphosphonate (BPP) treatment. This study analyze the incidence of JO in patients treated with BPP in our institution and reflects on prevention strategies.

Retrospective study of patients with bone metastasis treated with zoledronic acid from January 2015 to December 2018 and JO. Tumor type, number of BPP treatments, calcium metabolism disorders and stomatology consultation (SC) prior to the beginning of the treatments were evaluated. Data were analyzed using SPSS version 25.0.

We evaluated 520 patients; 19 developed JO during treatment with BPP. Mean age at diagnosis of JO was 58.5 years and 73.7% were female. Most patients had an ECOG-PS 0. Regarding the primary tumor, 68.4% had breast cancer, 21.2% prostate and 10.4% lung and thyroid. Only 2 patients were evaluated in SC prior to initiation of treatment. About 57.9% of the patients showed no change of calcium metabolism. One patient was not supplemented with calcium/ vitamin D. Only 4 patients underwent surgical intervention. None of the patients had permanent sequelae.

This study reinforces the importance of SC assessment prior to treatment, as well as the regular follow-up during the treatment. Therefore, multidisciplinarity in this condition should be considered the pillar of its prevention since, despite being a rare complication, JO can be considered a serious toxicity of BPP treatment.

Trismus is a symptom related to the treatment of head and neck cancer characterized by limited ability to open the jaw. The aim of this study is to note the incidence and severity of trismus and to evaluate its relationship with oral and systemic conditions.

The data of head and neck cancer patients who attended İstanbul University Faculty of Dentistry Department of Prostodontics between November 2018-March 2019 were evaluated. 20 patients (4 female) with mean age 56,65 ± 11,847 patients whose treatment was completed a year or more ago were examined. Results Our patient were treated; 50% RT with surgery, 25% RCT with surgery, and 25% RCT. 85% of the patients had problems about mouth opening and were within the trismus criteria (<35mm) mean 25,23mm. The painless mouth opening value was 27.90 ± 9.61167 mm, the maximum assisted mouth opening was 30.950 ± 9.8045 mm. The maximum unaided opening value was 29.850 ± 9.79 mm. The records of TMJ examinations were also investigated. 8 patients had reported pain in the jaw, temples, in the ear and in front of the ear. In only 40% (n = 8) of the cases, oral examinationbefore cancer treatment. No patient was informed regarding advising physical exercise to prevent trismus or any other long term oral complications.

Trismus and accompanying temporomandibular joint problems still remain as serious long-term complications of head and neck radiotherapy. In the pre-treatment period, the application of preventive treatments about trismus can contribute to the long-term quality of life.

Introduction HNS are rare malignant tumors of mesenchymal origin, associated with aggressive and infiltrative growth and high rate of recurrence. When they occur, their anatomical location and the surrounding structures involved, make their initial diagnosis and management challenging tasks to perform. RT of HNS has demonstrated benefits in local control and in cases of recurrence; however, side effects have been observed. Methods An update literature review was carried out with the aim of describing the extra-and intraoral manifestations in patients who underwent RT. For this purpose, a search was made in the electronic databases of Medline, PubMed and Science Direct. As a result, 7 articles were retrieved in English. They included results from systematic reviews, retrospective studies and case series, published between 2016 and 2021.

RT is based on local control of the disease, but side effects such as skin peeling, pigmentation, cutaneous fibrosis, alopecia and hearing damage were reported. Intraoral manifestations such as dysgeusia, dysphagia, dental disorders, mucositis, dry mouth, hyposalivation, viral and fungal infections such as herpetic and candidiasis respectively were described. Conventional and adjuvant therapies such as photobiomodulation (PBM) and topic hydrogels were alternatives cited for control and relief. Conclusions RT has shown better clinical response for local control, but side effects occurred frequently. Combined therapies to manage those were shown to be essential for improving the quality of life of the patients.

The most largely used definition and staging system of Osteonecrosis of the Jaws (MRONJ) is based on clinical features (bone exposure for at least 8 weeks, or bone to be probed through a fistula), released by an American Association Oral Maxillofacial Surgery (AAOMS) task force, and adopted by MASCC. A team supported by the Italian Societies of Oral Medicine (SIPMO) and Maxillofacial Surgery (SICMF) suggested adoption of imaging tools (mainly Computed Tomography, CT) together with clinical features to evaluate real disease extension. Methods Data of cancer and myeloma patients with signs of MRONJ were reviewed in two referral centers to compare the stage of MRONJ cases at first observation time, according to two staging systems.

We collected data from 157 MRONJ patients (breast cancer/myeloma/ prostate cancer/other solid tumors: 77/28/28/24). The AAOMS stages were 0/I/II/III respectively in 34/40/56/27 observed cases. The SIPMO-SICMF stages were I (CT involvement of only alveolar bone)/ II (extended to extralveolar bone) /III (complicated case) respectively in 50/80/27 cases. The 34 AAOMS "stage 0" cases (signs/symptoms without bone exposure) were reclassified as stage I (14) or II (20) or III (0), respectively.

The AAOMS definition and staging system appear inadequate, potentially exposing patients to delayed diagnosis and treatment. The diagnosis and staging should be based not only on clinical data but also on the CT findings of the maxillofacial region 

There are no standard guidelines on oro-dental care during induction therapy of acute leukemia (AL). Comprehensive oral hygiene management protocols reduce infections. However, the effect of such an intervention has never been prospectively evaluated in a randomized study Methods Newly diagnosed patients with AL (ALL and AML) were randomly assigned to 1:1 ratio to receive standard oral hygiene protocol (group A) or comprehensive oral hygiene protocol (group B). In group A, the oral hygiene indexes(OHI) were measured by dentist at baseline and end of treatment . In group B, weekly monitoring of OHI, oral cavity inspection, probing for gum health, use of a soft tooth-brush and oral hygiene education were carried out. The primary objective of the study was to compare the highest grade of mucositis.

Patients were randomized to group A (n = 92) or group B (n = 91) with similar baseline characteristics. The adherence to oral mouth wash protocol was significantly better in the group B (41.7 % vs 66.7%, P=0.004). The frequency of mucositis was higher in group B (60%) compared to group A (47.2%) P=0.09. There was no difference in the median OHIS index (0.5 vs 0.6) and Plaque Silness index (0.4 vs 0.25). The local (1% vs11 %, P=0.005) and systemic infection rate (65.2%vs 82.2 %, P=0.009) were higher in group B.

This study failed to show superiority of comprehensive oral hygiene protocol in reducing oral mucositis in patients receiving induction therapy for AL. We hypothesise that frequent interventions in oral cavity may lead to dissemination of infection. 

There is increasing recognition of survivorship needs following cancer therapy in general, including oral and dental health following Head and Neck radiotherapy (HNRT) and the maintenance of adequate oral function. The aim of this study was to assess the most prevalent dental adverse events (DAE) leading to post-HNRT extraction and to investigate the impact of different radiation dose on DAE patterns and on the time that teeth were extracted following HNRT, as well as post-HNRT dental extractions outcomes. Methods A retrospective dosimetric-based analysis was conducted to assess DAE affecting post-HNRT extracted teeth and the impact of 3 different radiation doses (< 30 Gy, 30-60 Gy, and > 60 Gy) upon tooth loss. Post-HNRT extractions outcomes, mean parotid glands dosimetry and salivary changes were secondarily analyzed. Results 1,071 teeth from 66 patients who underwent HNRT were included. Radiation-related caries (RRC) was the most frequent (67.8%) post-HNRT DAE and maxillary molars ipsilateral to the tumor was early lost (p < 0.001) compared to the other groups. The odds ratio for post-HNRT tooth extraction risk was approximately 3-fold higher for teeth exposed to > 60 Gy (CI: 1.56-5.35; p < 0.001), followed by an increased risk of delayed healing and osteoradionecrosis (ORN) in sites receiving > 50Gy.

In our study, RCC was the major cause of dental extractions following HNRT and the dosimetric analysis suggested that high dose of radiation may negatively impact the dentition of HNC survivors, increasing the risk of tooth loss and ORN.

Withdrawal of angiogenesis inhibitors such as bevacizumab (BV) is recommended during thoracotomy and laparotomy. However, the need for withdrawal during tooth extraction remains unclear. Hence, we present a survey of patients on BV administration who underwent tooth extraction with or without BV withdrawal.

We included 24 patients (67 tooth extractions) admitted to our department from Apr. 2012 to Mar. 2019 and who had been treated with BV alone or a regimen including BV and underwent tooth extraction. Patients with BV administration at least 21 days (half-life of BV) prior to tooth extraction were categorized into the "withdrawal group" (15 patients), whereas those with less than 21 days since BV administration were classified into the "continuation group" (9 patients). The adverse events of the drug were retrospectively analyzed.

In the withdrawal group, five patients (10 tooth extractions) showed adverse events, of which three had delayed healing, one had post-extraction bleeding, and one experienced both. In the continuation group, however, one patient (1 tooth extraction) experienced post-extraction bleeding. There were no significant differences in the occurrence of adverse events between the continuous and withdrawal groups. Of the 11 teeth with all post-extraction adverse events, eight were mandibular molars.

Our study suggests that aggressive BV withdrawal during tooth extraction may not be necessary. However, during surgical extractions of mandibular molars, BV withdrawal may be considered. 

To evaluate oral hygiene level and oral mucositis in patients undergoing treatment for head and neck cancer. Methods Patients scheduled to undergo curative treatment for head and neck cancer are included. All patients are advised to brush their teeth twice a day and to clean interdentally once a day. Patients visit the dental hygienist once a week for professional oral care and reinstruction in oral hygiene if needed. Patients in the control group follow ordinary routines (visit the dental hygienist once a week for professional oral care). Dental plaque and gingival bleeding are registered on four sites on 6 teeth. Mucositis is scored using Oral mucositis assessment scale (OMAS). Preliminary Results 40 patients (26 men, 14 women) have completed the study so far. The most common diagnosis was tonsil cancer (n=20). The most common treatment modality was RT+chemotherapy (n=20). Twenty patients were randomized to the control group and 20 to the intervention group.Preliminary results shows that the mean plaque scores were slightly lower during RT in the Intervention group. The scores for gingival bleeding week 2 and 4 during treatment was slightly lower (0.23±0.19 compared with 0.10±0.16, and 0.41±0.47 compared with 0.18±0.38) in the intervention group. The onset of oral mucositis was later (week 2 compared with week 1) and the OMAS scores tended to be lower in the intervention group.

The preliminary results indicate that optimal oral hygiene might postpone oral mucositis and decrease its severity. 

Allogeneic "off-the-shelf" adipose-derived mesenchymal stem/stromal cell (AT-MSC) therapy may be a novel approach to alleviate radiation-induced salivary gland (SG) hypofunction and xerostomia.

In this investigator-initiated, first-in-human, single-center, open-label, phase 1 trial ten previous oropharyngeal squamous cell carcinoma stage I-II patients (UICC 8) with radiation-induced SG hypofunction and xerostomia were treated with allogeneic AT-MSC and followed on day 1, 5, 30 and 120. The study drug contained 50 million AT-MSC/ml and 25 million were injected in each submandibular and 50 million in each parotid gland. Data were collected on adverse events (AE, primary outcome), unstimulated and stimulated whole saliva (UWS and SWS) flow rates and patient-reported outcomes (EORTC QLQ-H&N35 and Xerostomia Questionnaire [XQ]). Data was analyzed using repeated measures linear mixed models.

No serious AEs occurred. After 4 months, UWS flow rate increased from 0.13±0.02 ml/min at baseline to 0.18±0.02 ml/min (p=.0009). SWS flow rate increased from 0.66±0.11 ml/min to 0.75±0.11 ml/ min (p=.0167). XQ summary score decreased with 22.6 (p=.0004), EORTC QLQ-H&N35 domains decreased for dry mouth with 26.7 (p=.0013), sticky saliva 23.3 (p=.0015), and swallowing 10.0 (p=.0016).

Our trial suggests that injection of allogeneic AT-MSCs is safe and increased UWS and SWS flow rates and decreased xerostomia in patients with radiation-induced salivary gland hypofunction and xerostomia.

Obturators are dental prostheses worn to restore form and function in people with palatal defects, often resulting from maxillectomy. This is the first Australian study investigating quality of life (QOL) impacts of obturators. Methods Thirty-one Adelaide Dental Hospital patients with obturators were interviewed. Participants completed two surveys: The Obturator Functioning Scale, and University of Washington Quality of Life v4.1. Demographic and treatment data were collected. Univariate regression analysis was performed. The P value for significance was set as <0.05.

The median value for overall QOL over the past seven days was 60, equating to a rating of 'good' (IQR 60-80). Predictors of better overall QOL were Australia as country of birth (OR=19; 95% CI: 3, 148), English as a first language (OR=18; 95% CI: 1, 278), and higher number of natural upper teeth (OR 1.19 per additional tooth; 95% CI: 1.01-1.41). Predictors of physical function were a mix of physical and demographic factors, while predictors of social and emotional function were the same as those for overall QOL.

Better physical functional outcomes were associated with a mix of sociodemographic and physical factors, while country of birth and first language were the greatest predictors of overall and health-related QOL. These results can be used to further direct clinical assessment, focus the information and education needs for patients planned for an obturator prosthesis, and identify those patients who may require additional support.

Oral complications during and after hematopoietic stem cell transplantation (HSCT) may negatively impact treatment outcome. Oral health before HSCT may influence development of complications but evidence-based treatment guidelines for oral conditions are lacking. The aim of this study is to describe oral health in patients planned for HSCT. Methods 275 patients planned for HSCT were included in a prospective observational study (Orastem study). The patients had a mean age of 53 years, 58% were males. Pretreatment oral assessments were performed up to 8 weeks before HSCT.

Diagnoses were multiple myeloma (29%), AML (24%), lymphoma (15%), MDS (7%), ALL (6%), myeloproliferative neoplasms (6%), CML (4%), other (9%). Almost 30% had ≥1 tooth with pocket depth >5 mm; over 20% had ≥1 tooth with apical periodontitis; 46% had ≥1 tooth with caries. 16% reported oral symptoms when they became ill with the condition requiring HSCT. 60% reported oral symptoms from earlier chemotherapy; taste changes, dry mouth and mucositis being most frequent. For oral health-related habits, 23% performed tooth brushing <twice/day and had significantly more caries (p 0.003), smokers (6%) had significantly less teeth than non-smokers (p 0.005).

Many patients planned for HSCT have oral health problems. More research into the impact of these oral problems on transplant outcomes and QoL is necessary.

Symptoms of oral chronic Graft-versus-Host-Disease (cGVHD) may significantly affect the Oral Health-related Quality of Life (OHRQoL). This study aimed to assess the OHRQoL in patients with oral cGVHD, and to examine whether oral cGVHD symptoms, oral mucosal cGVHD and salivary gland function correlated with OHRQoL. Methods Patients referred to the oral cGVHD outpatient clinic were included. Severity of oral mucosal cGVHD, oral cGVHD symptoms and OHRQoL was assessed by the NIH OMS, NIH OSS and OHIP-14, respectively. Unstimulated and stimulated whole salivary flow rates were determined, and categorized into 'hyposalivation', 'normal salivary flow' and 'hypersalivation'.

Of 56 included patients, 80% had mild, moderate or severe oral mucosal cGVHD. Mean total score of OHRQoL was 16.5 (±11.7), negatively affected by functional problems. Patients reported highest scores regarding oral sensitivity and xerostomia. Significant correlations were found between severity of oral pain and OHRQoL, and between oral sensitivity and OHRQoL. No correlation was found between oral mucosal cGVHD and OHRQoL. Patients with hyposalivation, normal salivary flow and hypersalivation reported equal levels of OHRQoL.

Results demonstrate that the OHRQoL was mostly negatively affected by complaints of oral pain and oral sensitivity and less by the severity of oral mucosal cGVHD assessed by the NIH OMS score. Special attention of (oral) health care professionals for patients with oral cGVHD is mandatory to alleviate their symptoms and improve OHRQoL. Background While prophylactic pre-radiation (RT) dental extractions may reduce longterm oral toxicities like osteoradionecrosis in head and neck cancer (HNC) patients, the factors influencing the prophylactic dental care provided have not been investigated. This study examines the impact of dental insurance on the rate of prophylactic pre-RT dental extractions in HNC. Methods A retrospective cohort study was conducted on a consecutive sample of HNC patients who underwent pre-RT dental assessments from January 1, 2011 to January 1, 2018 at our tertiary-care centre. Eligibility criteria included age ≥ 18 years, planned for curative RT of ≥ 45 Gy and no prior RT.

Of 3701 eligible patients, 2746 underwent pre-RT dental assessment. Of these, 49.6% had limited (public) or no dental insurance and 50.4% had private insurance. Dental examinations and extractions are paid for by the provincial health insurance program. On multivariate analysis, lack of private dental insurance associated with prophylactic pre-RT tooth extractions with adjusted Odds Ratio (95% CI) of 2.72(2.43-3.06) for public dental insurance and 1.91 (1.76-2.06) for no dental insurance (both p<0.001).

Given two patients with near equivalent dental histories and HNC diagnoses, the one without private dental insurance would be far more likely to be deprived of their dentition prior to RT. We conclude that patients without private dental insurance may experience inequity when universal coverage for medically-necessary pre-RT dental care in HNC patients is limited to extractions. 

Nivolumab(N) can induce immune-related adverse events(AE). Our aim is to evaluate detection and management of N-related thyroid toxicity in our hospital.

Observational study of patients with melanoma, renal cell carcinoma(RCC), Hodgkin lymphoma(HL) or cancer of the head and neck(CHN) who started N treatment from January2016-June2019. Results 45 patients received Nivolumab: 71,1% males, mean age 68(rank 37-87), tumor types: melanoma 57,78%, RCC 26,67%, CHN 13,33% and HL 2,22%. They received N for a median of 11 cycles. Thyroid function(TF) tests: TSH, free T3 and T4 blood levels; were realized in all patients treated with N. Test had no periodicity, depending on the oncologist and patient's previous TF. 6 patients presented hypothyroidism before N exposure: 5 treated with levothyroxine requiring close manage of TF during treatment, 4 of them increased doses. 1 patient with subclinical hypothyroidism started taking levothyroxine. 2 patients were diagnosed of N-related hyperthyroidism grade 1:one primary hyperthyroidism requiring beta-blockers and one subclinic hyperthyroidism. 5 developed hypothyroidism: subclinical in 4 cases:2 grade 1 (one required levothyroxine and the other TF monitoring) and two grade 2 (both required levothyroxine);one patient presented grade 2-3 primary hypothyroidism requiring levothyroxine, corticosteroids and N suspension until recovery. Conclusions Nivolumab-associated thyroid dysfunction (as hypo/hyperthyroidism) is an important AE. Having an standardized protocol about TF management would be convenient.

Limited evidence exists examining sex differences in symptom relief from medical cannabis (MC) in patients with cancer. Methods This is an analysis of cancer patient data from the Quebec Cannabis Registry. Patients completed the revised Edmonton Symptom Assessment System (ESAS-r) questionnaire at baseline and 3-month follow-up. We examined the interaction between sex and time on each ESAS-r symptom, and the interaction between sex, time and THC:CBD ratios on total symptom burden.

The analysis included 358 patients (M=171). There were no sex differences in baseline ESAS-r scores. Three months of MC therapy led to (Figures 1,2) . Only F perceived improvements in drowsiness (-1.1±0.4, p<0 .05), nausea (-0.9±0.3, p<0.05), lack of appetite (-1.7±0.4, p<0.001) , and shortness of breath (-0.9±0.3, p<0.05). Neither sex experienced a significant impact of MC on depression. THC:CBD balanced products significantly reduced total symptom burden in M (-14.7±3.6, p<0.01) and trended towards significance in F (-9.9±3.1, p=0.074). F had a greater, but non-significant response to THC-dominant products (-13.4±4.7, p=0.161) (Figure 3) .

The perceived relief of cancer symptoms from MC differs between sexes. THC:CBD balanced products appear to have a more consistent effect in decreasing total symptom burden in both sexes.

Investigating how diabetes treatment impacts cancer survival can inform best practice for treating diabetes among patients with both breast cancer and diabetes Methods We conducted a systematic review and meta-analysis to determine the effect of different diabetes treatment on breast cancer outcomes. The following databases were searched from their foundation until May 2015: MEDLINE, EMBASE, Web of Science, Cochrane, and PubMed epubs. The search was updated in 2017. Study selection was performed by 2 independent reviewers. 32 studies out of the initial 8168 identified studies met selection criteria. Data was pooled using a random effects model.

In pooled analysis of 19 studies, metformin users improved OS compared to non-metformin users (HR 0.63, 95% CI 0.54, 0.74). 2 studies comparing metformin monotherapy only vs insulin monotherapy also showed better OS (HR 0.64, 95% CI 0.45, 0.91). Pooled analysis from 8 studies comparing sulfonylurea users to non-users showed worse survival with sulfonylurea use (HR 1.43, 95% CI 1.11, 1.84) . Pooled estimates from 9 studies showed that compared to patients not treated with insulin, insulin users had worse OS (HR 1.60, 95% CI 1.20, 2.13) . Sensitivity analysis and meta-regression performed showed no significant change in the risk estimates.

Among patients with diabetes and breast cancer, metformin appears to provide a survival benefit when used as treatment for diabetes, compared to other drugs. IntroductionTo enable informed decision-making about cancer treatment, clinicians must effectively communicate Western medicine to groups with different cultural perceptions. Methods Audio-recorded, semi-structured interviews were conducted face-to face or via telephone with health professionals experienced in effectively communicating cancer to Aboriginal and Torres Strait Islander peoples, to ascertain their successful strategies. Thematic analysis used a bottom up, essentialist/realist approach.

Of 23 health professionals interviewed from medical, radiation, nursing oncology, and Aboriginal health; 12 (52%) were female, 11 were male (48%), and 5 (22%) also identified as Aboriginal. Five primary themes were identified: (1) Creating a safe environment/engendering trust and building rapport, (2) Using specific communication strategies e.g. metaphors with familiar illustrations like trees with roots or blocked pipes, (3) Using cultural mentors to assist with communication, such as Aboriginal health workers, (4) Considering cultural beliefs e.g. collective decision making and the cultural obligations of individuals (5) Displaying personal qualities of a good communicator by showing respect and patience. Conclusions These insights will enable the creation of educational modules for inexperienced clinicians, aiming to increase understanding of cancer and Western treatment, creating a positive interaction with the health system and promoting optimal outcomes for Aboriginal and Torres Strait Islander peoples with cancer. 

Exercise training is a safe approach to counteract some chemotherapyrelated side effects. This study aims: (i) to report adherence to a supervised exercise training program (SETP) for women with breast cancer (BC) receiving doxorubicin and cyclophosphamide (AC), and (ii) to identify predictors of SETP-related adherence, using data from an ongoing trial (ISRCTN32617901). Methods Twenty-one women with early BC undergoing AC were randomly assigned to a SETP involving 3 sessions per week of aerobic training combined with resistance training. Adherence is reported throughout the AC treatment and between each cycle. Baseline demographical, clinical, physical fitness and health-related quality of life variables were analyzed by a bivariate and linear regression analysis.

The overall mean adherence to SETP was 73.4% ± 17.7%, but significant differences were found between AC-cycles. Mean Adherence during the 4th AC-cycle (64.2% ± 27.5%) was significant and borderline lower comparing with the 2nd AC-cycle (80.1% ± 18.7%; p=.03) and 1st AC-cycle (76.9% ± 22.6%; p=.058), respectively. Adherence during the 3rd AC-cycle was 72.2% ± 25.4%. By performing a multiple linear regression model, only lower limb function assessed by sit-to-stand test (B=2.34; p=.032) was significant in predicting SETP-related adherence.

These preliminary results revealed a good adherence to a SETP during AC, although with a downward trend from the 2nd AC-cycle. Baseline performance in sit-to-stand test may be used as a predictor tool for exercise adherence in this population. 

Collecting patients' experiences with cancer care provision is essential when evaluating whether care is patient-centered. We conducted the first large patient experience survey in western Switzerland to provide robust evidence on the perceived quality of cancer care.

The Swiss Cancer Patient Experience (SCAPE) cross-sectional multicenter survey was conducted between October 2018 and March 2019, recruiting patients from four large cancer centers in French-speaking Switzerland. We invited 7145 adult cancer patients to complete the survey, including questions translated and adapted from the NHS Cancer Patient Experience Survey. Of the 3121 (43.7%) patients who returned the questionnaire, 2755 (88%) reported at least one eligible cancer (breast, prostate, lung, colorectal, melanoma, or hematological) and were included in the analyses.

Results show that patients globally reported positive experiences with diagnostic tests, clinical nurse specialist (when available), surgery, and hospital care. Less positive experiences were reported in relation to supportive care issues, in particular regarding psycho-social, financial, family-and survivorship-related aspects of care, and regarding the information received at diagnosis and about treatment side-effects and symptoms.

Our results are being discussed with the participating cancer centers to guide patient-centered initiatives and further develop the quality of cancer care in Switzerland.

Although sexual health (SH) is a major concern for many breast cancer (BC) patients, only few of them receive adequate information on this topic throughout their care. BEROSE is a single-center pilot cross-sectional observational study, which aimed at evaluating communication on SH between women with BC and their healthcare providers. Methods From June 12th to July 31th, 2020, a paper or digital survey was distributed to patients consulting in the Breast Cancer Unit of Gustave Roussy Cancer Center. The primary endpoint was the rate of women reporting to have received information on SH from health professionals throughout active treatment administration or BC follow-up.

Of 348 surveys collected, 318 were completely filled and included in the analysis. Sixty one percent of women were older than 50 years and 65% of our sample had a localized BC. The majority (63%) was receiving chemotherapy (26%) or hormone therapy (37%). Overall, 65% reported that they had not received any information about SH throughout their care, while 69% felt it was important to discuss sexual issues. Additional analyses have been performed and can be eventually presented at the congress.

Our study suggests a deficiency of patient-perceived communication regarding SH-related issues among women treated or followed-up for breast cancer. The impact of BC diagnosis and treatment on SH should be approached with all women from the first visit and then regularly readdressed over treatment and follow-up.

Data on uptake of rehabilitation components for people with thoracic cancer (lung cancer or pleural mesothelioma) delivered during a randomised controlled feasibility trial is presented Methods Short-term rehabilitation aimed to optimise symptom control, physical function and social participation in people with thoracic cancer within 8 weeks of diagnosis.1 Participants received 1-3 rehabilitation sessions over 6-8 weeks. Theory informed intervention design and evaluation. Intervention components were tailored to individual goals and integrated alongside cancer treatment. Functional concerns and intervention uptake, extracted from case-report forms, were mapped to theoretical domains. Results 374 people were screened (February 2018-January 2018). 54/159 (34%) eligible people were randomised to receive standard care and rehabilitation (n=26) or standard care(n=28). Median(range) age 67(44-85), 35(65%) men. Experiences of illness and symptoms impacted function across all WHO-ICF domains: social participation (19/76%); physical function (n=17/68%); domestic activities (17/68%); breathlessness/cough (n=15/60%); mobility (11/ 44%); work (7(28%); nutrition (5/20%) and pain (n=4/16%). Participants engaged with rehabilitation in all WHO-ICF domains, targeting physical activities (n=24/96%); symptoms (n=20/80%) and participation in activities (n=20/80%).

Functional concerns reported and uptake of rehabilitation components suggest comprehensive underpinning theory. All rehabilitation components should be retained in a future efficacy trial.

I. Chan 1 , C. Shen 1 , C. DeAngelis 1 , C.Peragine 1 , M. Thomas 1 , P. Mark 1 , V. Anju 1 , T. Chantal 1 1 Sunnybrook Health Sciences Centre, Pharmacy, Toronto, Ontario, Canada

Acute nephrotoxicity is the most concerning toxicity with high-dose methotrexate (HDMTX). Adult patients are routinely admitted for HDMTX infusion and discharged when MTX levels are ≤0.1uM. We aim to determine the incidence of HDMTX-induced nephrotoxicity to assess the feasibility of ambulatory HDMTX.

This is a retrospective single-arm cohort study conducted at Sunnybrook Health Sciences Centre (SHSC) on all HDMTX (≥500mg/m2) cycles administered between January 1, 2018 to December 31, 2019. Incidence of nephrotoxicity was defined by the number of cycles patients developed renal toxicity as per RIFLE criteria, and the number of cycles with a ≥10% increase in serum creatinine (SCr) from baseline within 10 days of infusion. Results A total of 74 patients and 200 cycles were included in the analysis; median age was 54.5 (range 19-80) years. As per RIFLE, 16 (8%), 3 (1.5%), and 1 (0.5%) cycles were identified as nephrotoxicity risk, injury, and failure, respectively; where the median onset and duration of nephrotoxicity were 4.72 (range 0.65-9.01) days and 9 (range 2.01-36.84) days, respectively. Sixty (30%) cycles had SCr elevation of ≥10%. Median time to MTX levels ≤0.1uM was 2.75 (range 0.75-12.54) days.

Inpatient HDMTX administration following current SHSC protocol is safe and does not give rise to significant nephrotoxicity. Consideration of ambulatory HDMTX could improve patients' quality of life and reduce strain on healthcare resources.

Cooling of hands and feet to prevent taxane-induced peripheral neuropathy and nail toxicities is typically performed using frozen gloves. Hilotherapy produces cooling at a constant temperature, but comparative data with frozen gloves are unavailable.

We conducted a prospective self-controlled study exploring the efficacy of hilotherapy at the right compared to frozen gloves at the left in patients with early breast cancer treated with paclitaxel or docetaxel. Patient-reported outcomes were collected at baseline, 6, 12, 18 and 24 weeks after the start of treatment. Primary and secondary endpoints were the incidence of any-grade and ≥ grade 2 side-effects (peripheral neuropathy, pain and nail toxicities), and perceived comfort of both interventions.

Sixty-two patients participated. The incidence of any-grade side-effects was similar on both sides, 85.5% with hilotherapy and 90.3% with frozen gloves (p=1.000). The incidence of ≥ grade 2 sideeffects at the extremities was significantly lower with hilotherapy: 43.6% compared to 61.3% with frozen gloves (p=0.013). Perceived comfort was significantly better for hilotherapy than for frozen gloves (p<0.0001).

Continuous cooling of hands and feet using hilotherapy produces better prevention of ≥ grade 2 patient-reported side-effects compared to frozen gloves and is perceived significantly more comfortable. From a clinical and patient perspective, hilotherapy is a better alternative for achieving Introduction Hypersensitivity reactions (HR) to antineoplastic drugs can lead to the suspension of potentially effective treatments. The possibility of proceeding with these treatments with desensitization (DSS) protocols is an alternative to consider. The authors intend to characterize a population of patients treated with a DSS protocol, evaluating efficacy and safety. Methods Retrospective, descriptive, single-center study of patients with HR to antineoplastic drugs that received at least one treatment with a DSS protocol (2015-2020). Survival was calculated according to Kaplan-Meier.

Fifty-nine patients were included, 66% female, median age 63 years (30-87), 85% with ECOG <2 and 73% under palliative treatment. Most frequent primary tumors were colorectal (41%) and gynecological (20%). Most frequent drugs were platins (70%). HR were mostly grade 2 (CTCAE v.5) (54%), occurred mainly in the first 2 treatments (66%) and 32% of patients had previously been exposed to the drug. A total of 282 DSS protocols were performed, median follow-up was 17 months, 97% of patients completed preconized treatment. In palliative setting, PFS was 10 months (95% CI:7-13) and OS 18 months (95%CI:13-23), with 12-months survival rate of 73%.

Treatments with a DSS protocol, on an outpatient basis, is feasible and safe. Heterogeneity and sample size may hamper oncologic efficacy endpoints. However, conclusion of the pre-planned treatments in the majority of cases and survival outcomes in a palliative pre-treated population are enthusiastic findings.

This is a descriptive, cross-sectional study aiming to examine stoma compliance, quality of life and coping styles in colorectal cancer patients with stoma.

The sample of the study consisted of 145 colorectal cancer patients who met the inclusion criteria. The data were obtained using the Patient Information Form containing socio-demographic and disease characteristics, the Ostomy Adjustment Inventory-23 (OAI-23), the Quality Life Scale for the Ostomy Patients (QLSOP), and the Stress Coping Scale (SCS). In the data evaluation, the relationships between numerical variables were tested with the Pearson correlation coefficient.

The mean age of the patients was 60.80 ± 13.17, 62.1% were male and 67.6% had temporary stoma. In our study, it was found that there was a statistically highly significant and strong positive correlation between the OAI-23 and the QLSOP total and subscales (p <0.001). It was found that the greater use of active coping methods improves patients' quality of life and their adaptation to life with stoma during stressful situations (p <0.01); correspondingly, the greater use of passive coping methods, decreases patients' level of quality of life and adaptation to life with stoma (p <0.05).

It was determined that colostomy patients' better adaptation to life with stoma increases their quality of life. In addition, the use of active coping methods to deal with stress effectively increases both patients' quality of life and their adaptation to life with stoma.

Cancer patients receiving anti-cancer treatment experience multiple symptoms concurrently. This study aims to explore perceived patientcentered care (PCC) and its association to symptoms experienced by cancer patients receiving anti-cancer treatment. Methods A cross sectional study was conducted at an outpatient cancer center between August 2018 and July 2019 in adult cancer patients receiving at least chemo-or biological therapy as part of the treatment protocol.

Patients were asked to complete the three subscales (physical, psychological and global distress) of the Memorial Symptoms Assessment Scale and the perceived PCC questionnaire. To examine the association between participants' perceived PCC and symptoms scale scores, regression models were performed.

Of the 125 participants, 57 (45.6%) were diagnosed with breast cancer and were treated with chemotherapy either alone (n=62, 49.6%), with radiotherapy (n=4, 3.2%) or with biological therapy (n=45, 36.0%). Perceived PCC contributed to 11.3%, β=-.351 (p<.001); 8.9%, β=-.311 (p<.001); and 10.3% β=-.336 (p<.001) of the variance of the global distress, physical and psychological symptoms, respectively. Conclusions Perceived patient-centered care is important in alleviating physical and psychological symptoms and overall distress in cancer patients undergoing active anti-cancer therapy. Our findings call for oncology teams to adopt and implement patient-centered care as part of their routine work.

A better understanding of structural barriers for physical activity (PA) among people with cancer could help to improve PA after the diagnosis. Thus, the aim of the present study was to identify determinants of the perception of structural barriers and evaluate its impact on post-diagnosis PA.

In a cross-sectional study, 1299 people with breast, prostate or colorectal cancer reported socio-demographic and medical characteristics, pre-and post-diagnosis PA and perceived PA impediment by seven structural barriers. Regression analyses were used to identify determinants of structural barrier perception and to examine the association between structural barriers and insufficient post-diagnosis PA, also with regard to different pre-diagnosis PA levels.

Overall, 40-60% of participants indicated PA impediment by a lack of disease-adjusted PA offers and support. A younger age, higher BMI, lower educational level, no current work activity, co-morbidities and lacking physicians' PA counseling were significantly associated with the perception of structural barriers (all p's<.05). Individuals reporting stronger impediments by structural barriers were significantly more likely to be insufficiently active post-diagnosis, particularly those with sufficient pre-diagnosis PA levels.

Structural barriers seem to substantially impede PA among people with cancer. Our results highlight important target points for the development and implementation of supportive interventions that help overcoming structural barriers and improving PA after the diagnosis.

A. Fairchild 1 , J. Boora 2 , S. Ghosh 3 , S. Sidhoo 2 1 Cross Cancer Institute, Radiation Oncology, Edmonton/Alberta, Canada 2 University of Alberta, Faculty of Medicine, Edmonton/Alberta, Canada 3 Cross Cancer Institute, Experimental Oncology, Edmonton/Alberta, Canada

The Canadian Association of Radiation Oncology (CARO) Annual Scientific Meeting (ASM) provides opportunities to discuss new developments and disseminate knowledge. We explored the prevalence of palliative research at the CARO ASM between 2009 and 2020.

Published abstracts were independently reviewed by two authors who categorized each as: curative-intent; palliative-intent; pertaining to or including both populations; or neither. Abstracts were considered palliative if they described incurable malignancy and interventions primarily for symptom control or QoL. Study type, primary, site treated, and symptoms palliated were recorded. Summary statistics were calculated including one-way ANOVA and chisquare test for trend. Results 222/2995 abstracts (7.4%, range 2.4-13.9% per year) were classified as palliative. 37.4% were retrospective. Primary sites were mainly lung (31/ 222) and genitourinary (16/222); 64.9% aggregated multiple primaries. Most commonly treated metastases were bone (36.0%) and brain (12.6%). Quality of life, symptom and toxicity outcomes were reported in 32.4%, 27.0% and 17.1%, respectively. The primary symptom palliated was pain (23/222). Our results do not significantly differ from previous: 7.6% presented from 2003 to 2008 (p=0.99), and 6.7% from 1992 to 2002 (p=0.77) were palliative, confirmed by trend analysis examining all years 1992-2020 (p=0.47).

Despite the prevalence of PRT in clinical practice, the proportion of palliative abstracts presented at the CARO ASM has not significantly changed in 29 years.

According the patients with the long-term bed rest, those people have position turnover needs for preventing bedsore, therefore, Da-Yeh University designed to development the new type of mattress and expected to be meet with the turnover needs for those people desires.

This creation was jointly developed by Taichung Veterans General Hospital and Daye University to carry out creative research and development, adding the function of mattress assisted the patients with the longterm bed rest, for example, to allows the mattress to be folded helping those people have body position turnover needs, to avoid the problem of bedsores, so this mattress expects to be able to help patients turn over.

The mattress was designed and developed with the Taiwan patent certificate (No M550088) at the current stage. This study assumes that the demand of mattress for patients with the long-term bed rest is to help those people turn over, thereby preventing the bedsore, such as patients with cancer, and the research is still processing as well.

The research results will provide medical supplies development of the Long-Term Care and Intelligent Assistive Device Laboratory in the future and to understand the demands of the patients with the long-term bed rest, and to avoid the problem of bedsores, then therefore to help their turn over.

Cancer has always been the number one cause of death in Taiwan, and liver cancer has also been included in the top ten list of cancer deaths. With the development of treatment methods for the digestive tract, it is also important to understanding the life satisfaction of patients. Therefore, the purpose of this study is to understand the life satisfaction of liver cancer patients of different genders. Methods Using the structured questionnaire for the 60 sampling, who are the patients with liver cancer, those people were conducted in a Medicine Center in Liouying of the Tainan. The difference between the gender was analysis by the frequency distribution and t-test.

The survey found that 39 males and 21 females who with liver cancer, most of them have marriage, the mean of age is 67 years old. The results of the study found that different gender of those patients with self-satisfied did have a statistically significant difference (p<0.05). There was also statistically significant difference (p<0.05) in the sexual satisfaction between different gender. Especially, the females in the study are both the lower score on the self-satisfied and sexual satisfaction than the males.

The results may make medicine staff to understand the self-satisfied and sexual satisfaction for patients with liver cancer and therefore to have an attention related to improve those people life satisfactions. The relevant research results still need to be further explored and providing reference for future clinical data and therefore improvement of their life. 

A patient with manifestation of rare disease mentual neuropathic complications of mandibular bonemetastasis of prostate adenocarcinoma between diagnosis osteonecrosis in the jaw.

A 68 years old men had a history of bone tibia and spinal metastatic prostate cancer undergoing bilateralorchiectomy for hormone block (Sept/2017) plus chemotherapy with disease progression with no critical points besidesan increase in alkaline phosphatase; therapy with abiraterone and zoledronic acid quarterly was introduced in Sept/2018.The patient attended a dental appointment referred by the clinical oncologist in July/2019, complaining of a "tingling"sensation in the right chin mentual region after tooth extraction in another service approximately 6 months ago withdiagnostic hypothesis of the medication-related osteonecrosis of the jaws. Intraoral exam showed edema in the rightmandible body extending to the painless, hardened chin, with exudate d r a i n a g e . A n i n c i s i o n a l b i o p s y w a s p e r f o r m e d andimmunohistochemical analysis showed a positive staining for cytokines and NK3, confirming the diagnosis ofadenocarcinoma metastasis. The patient was referred to continue the treatment with radiotherapy and subsequenttherapies with xofigo and zoledronic acid to improve symptomatology and control of the adenocarcino.

The early differential diagnosis between osteonecrosis and bone metastasis in the jaw is important to animmediate management which can improve the treatment and the quality of life to the patient.

In head and neck radiotherapy, metallic dental restorations (MDRs) within the radiation field can lead to exacerbation of oral mucositis caused by backscatter radiation and uncertain radiotherapy planning due to metal artifacts. In Japan, the radiotherapy guidelines recommend two representative MDRs measures: 1) with MDR removal or 2) without MDR removal (non-MDR removal) using MRI and a spacer. Therefore, measures against MDRs differ among each hospital. For elimination of cancer care disparities and appropriate control of medical care costs, it is important to clarify these costs. Therefore, we compared the public medical care cost of measures for MDRs. Methods A total of 5,520 head and neck cancer patients underwent radiation therapy in 2018. We estimated that the mean number of MDRs per person was 4.1 dental crowns and 1.3 dental bridges. We used a cost-minimization analysis to compare the costs of measures for MDRs.

The mean cost per person was estimated to be 121 720 yen for MDR removal and 54 940 yen for non-MDR removal. The difference in total public medical care cost between them was estimated to be 368 625 600 yen. In addition, the cost per person for MDR removal was 5.1 times the national dental care expenditure per person.

Our results suggested that non-MDR removal would be more cost effective than MDR removal. In the future, a national survey and costeffectiveness analysis including some outcomes (rate of local control, status of oral mucositis, frequency of hospital visits, and efforts of the medical professionals) are necessary. 

Gemcitabine-induced venous pain remains a clinically unresolved issue. This study aimed to identify differences between gemcitabine formulations associated with the venous pain in patients and suggest for countermeasure.

We retrospectively analyzed data from patients with cancer who had received chemotherapy including a lyophilized or liquid formulation of gemcitabine. The study was conducted at Ehime University Hospital using electronic medical records between January 2015 and July 2017. A multivariable logistic regression analysis with generalized estimating equations for longitudinal data was used to identify risk factors for venous pain over course. In addition, we investigated the pharmaceutical stability of gemcitabine in combination with dexamethasone which provides an anti-inflammatory effect and pH adjustment. Results A total of 1,150 treatment courses for 141 patients were evaluated. Venous pain occurred in 115 courses (10.0%) and in 49 patients (34.8%). The multivariable logistic regression analysis revealed that the liquid formulation of gemcitabine was significantly associated with venous pain (P < 0.001). In vitro experiments showed that the concentration, pH, and visual changes in the appearance of the mixed solutions did not change up to 24 hr.

The liquid formulation of gemcitabine increased the frequency of venous pain compared to that associated with the lyophilized formulation. Gemcitabine may be administered in a mixture with dexamethasone to reduce the possibility of venous pain in clinical practice.

No study has objectively examined changes in functional performance and energy expenditure after a brief (4-week) exercise intervention in advanced, non-cachectic, cancer patients. Methods A single group of advanced cancer patients (n=21; 13 women, 8 males, 59.3±14.4 years) under treatment were recruited to participate in a 4-week, home-based exercise program. The primary outcome measure was the 6-minute walk test distance (6MWTD). Energy expenditure was assessed using accelerometry and functional lower extremity strength was measured by the time it takes to complete 5 sit-to-stand tests. Therabands™ were used to provide progressive overload to muscles of the upper and lower body.

There was a statistical (413.1±92.2 vs. 457.3±106.2 m, p<0.001) improvement in the 6MWTD and sit-to-stand time (15.7±5.1 vs 12.7±3.0 s, p<0.025) from baseline to week 4. Similarly, significant increases were observed in energy expenditure (1775±412 vs 2142 ±470 kcals, p<0.001) and step count (3576±1565 vs 4943±2052 steps, p<0.001). There was an improvement in overall body strength as evidenced by the significant increase in elastic resistance in the chest press (21%, p<0.001), seated row (24%, p<0.001), and bicep curl (29%, p<0.001).

Comparisons between pre-post intervention outcome measures revealed promising improvements in functionality, walking capacity, and overall muscle strength.

Home-based chemotherapy is widely used and offers advantages in terms of patient-centeredness, hospitals' patient capacity, and financial value. However, in practice, some patients' needs remain unmet. This study explored patients' lived experiences during homebased chemotherapy. Methods A qualitative descriptive study was conducted in a tertiary hospital in South Korea. Ten patients with colon cancer undergoing home-based chemotherapy and 10 of their nurses participated. Data were collected using semi-structured individual interviews, which were recorded and transcribed verbatim. Data were analyzed using inductive content analysis.

Four major themes were extracted: (a) ambivalence regarding being more comfortable at home than when hospitalized but still enduring the suffering, (b) accepting the discomfort, (c) the necessity of newly developed devices for monitoring infusion, and (d) the need for tailored nursing care to address unmet needs and expectations for hands-on care at home at levels similar to those encountered in the hospital.

It is necessary to develop a tailored nursing program that allows nurses to provide care even over long distances. Moreover, a new style of device that addresses patient's unmet needs should be explored based on the need for more comfortable and convenient home-based chemotherapy for patients with cancer.

Head and neck cancer (HNC) treatment is associated with important toxicities. Exercise training (ET) benefits are reported for many cancer types, but only 9% of HNC patients meet physical activity guidelines. This pilot study aimed to establish exercise preferences of HNC patients and their interest in participating in a clinicsupported ET program. Methods A random sample of patients with locally advanced HNC proposed for curative intent treatment were recruited to the before treatment (BT) group or after treatment (AT) group, depending if they hadn't started or already concluded the anti-cancer treatment. Both groups answered a questionnaire about perceived exercise benefits and preferences. Results 30 patients were included, 90% were men, with a median age of 54 years. The majority recognized the health benefits of an ET program. In the AT group (n=11), most patients were willing to participate in an ET program before (91%), during (73%) or after (91%) treatment. The most common exercise preferences before and during treatment were a frequency of 2 times/week, moderate intensity, 15-30 min/bout. In this group, 46% also reported they were willing to exercise, at least, 3 times/week after the treatment, 73% more than 31 min. Among BT group (n=19), 79% were interested in participating in an ET program, mainly after treatment, 2 times/week, 15-30 min/bout at a light intensity. In both groups a supervised hospital or gym-based ET program was the preferred.

High serum C-reactive protein CRP is associated with poor prognosis in Upper Gastrointestinal (UGI) cancer. It is unknown which CRP cut-off value or CRP-based prognostic score should be used. This systematic review examined what CRP cut-off and score best predict survival in UGI cancers. Methods EMBASE, Medline, Web of Science, Cochrane, Scopus and CINAHL were searched. Inclusion: Adults with UGI cancers (oesophageal, gastrooesophageal junction and gastric), CRP or CRP-based score, Hazard Ratio for survival, English or French language. Exclusion: Duplicates, reviews, case series ≤5 cases. 2 investigators independently screened all papers at title/abstract and full text stages. Results 2078 papers screened, 87 included. CRP was pre op or pre chemotherapy for most; timing was unclear in 17. 35/50 studies found high CRP predicted poor survival. Cut-offs ranged from 1.5 to 10mg/L. 15/20 papers using a 10mg/L cut-off found it predicted survival. 19 different scores were reported, most commonly Glasgow Prognostic Score (GPS) and modified GPS. 23/31 studies found GPS predictive of survival. 17/26 studies found mGPS predictive.

This review confirms a significant relationship between CRP, alone or as part of a prognostic score, and survival in Upper GI cancer. The strongest evidence is for a 10mg/L cut-off and for the GPS and mGPS. Future studies should apply consistent CRP cut-offs or focus on the GPS or mGPS, and use standardised measurement timepoints.

The Multinational Association of Supportive Care in Cancer (MASCC) and the International Society of Oral Oncology (ISOO) hold a joint annual meeting to disseminate knowledge regarding advances in oncology. This study aims to examine the changes in abstract publications by comparing the MASCC-ISOO abstracts published in 2014 versus those in 2019.

The following items were extracted from 2014 and 2019 abstracts and were subsequently compared: first author region, retrospective vs prospective, experimental vs observational, review type, specific study type, and qualitative vs quantitative.

Of the 1387 abstracts published across both years, 108 abstracts (7.8%) were excluded (not true studies). Overall, 550 abstracts were published in 2014 and 729 in 2019 (Table 1 ). In 2014, palliative care (12%) contained the greatest percentage of abstracts, while in 2019 rehabilitation, survivorship and quality of life (14%) contained the greatest percentage of abstracts. There was an increase in systematic reviews (8% vs 6%), and retrospective (22% vs 15%) and quantitative (84% vs 77%) studies published in 2019 compared to 2014. Observational and cross-sectional studies were similar across both years.

More studies were published in 2019, and among these, the percentage of systematic reviews, retrospective and quantitative studies increased significantly from 2014 to 2019.

The main venous thromboembolism (VTE) risk prediction model for ambulatory cancer patients is Khorana. Cancer thrombosis is associated with elevated thrombin generation. Its quantification is a promising method for evaluating patient's thrombotic profile. The aim of this study is to develop a predictive model of VTE in ambulatory cancer patients, combining thrombosis biomarkers with Khorana model.

This is a prospective observational study from a Portuguese center that includes newly diagnosed cancer patients proposed for antitumor treatment (chemotherapy, immunotherapy or targeted therapies). Patients with disease progression are allowed if chemotherapy-free for 3 months. Exclusion criteria are major bleeding in the last 3 months, major surgery in the last 28 days, patients on anticoagulation/antithrombotic therapy. A 6-month mean incidence of VTE 6-10% is expected, requiring a sample size of 600 patients. Blood sample is collected at inclusion to analyze thrombosis biomarkers and blood counts. The primary endpoint is the occurrence of symptomatic or incidental VTE within 6 months of inclusion. Models will follow a logistic approach with K-fold cross-validation (k=10). Model quality will be assessed with AIC and BIC. Decision for entering predictors in multivariate models will be based on p <.10 in the univariate analysis.

Recruitment achieved 67% and is expected to be completed by the end 2021.

This study will result in a comprehensive risk model adapted to the diversity of anti-tumour treatments available. 

In addition to the Multidisciplinary Concertation Meetings (MCM), CSM, including not only oncologists but also caregivers, a member of the palliative care team, an intensivist and a psychologist, have been set up in our Comprehensive Cancer Center. These meetings are intended for patients (pts) with complex cases that require a multi-professional, transversal and multidisciplinary approach. With all the staff involved in the pt's care, the discussion varies from the goal of treatments, gradation of care, ethical and psychosocial issues and the pt's life plan and can lead to additional opinions for the MCMs, which may even reorient their decisions. Methods Initiated in a first unit, the CSMs have been extended to the entire medical oncology department since 2016. The situations examined are proposed by the caregivers themselves, depending on the difficulty of a case and/or the occurrence of particular events.

In 2020, 84 meetings were held and 114 pts were presented. The pts discussed, with an average age of 52.7 years, were in advanced stages of disease, with 74% of metastatic cancer. Most discussed pts had an altered general condition(91%); a significant undernutrition (57% ). During these meetings, 63 suggestions concerning oncological commitment, 34 proposals regarding the degree of intensification of medical care were made.

As distinct from onco-palliative MCMs, CSMs place the caregivers in the heart of the system and strive to reach consensual and consistent conclusions for all medical and nursing staff involved. 

For cancer patients, life-threatening complications may be difficult to anticipate, leading to complex medical decision-making processes. Since 2015, our Comprehensive Cancer Center has implemented a Decision-Aid Form (ADF), outlining the anticipation of appropriate care for patient in case of worsening evolution. Methods Between January and May 2017, all patients transferred from Site 1 to Site 2 of the hospital were prospectively included. In this study, we assessed the acceptability of the ADF, its using and its impact on the patient's becoming.

Out of 206 patients included, 89.3% had an ADF. The planned stratification of care was notified in practically all cases. Although a possible transfer to Intensive Care Unit was initially proposed in two-thirds of the patients, the majority (76%) of the 35 patients experiencing an acute event received exclusive medical or palliative care. The level of therapeutic commitment suggested by the ADF was never upgraded, and often revised towards less aggressive care, and especially without excess mortality for the patients who were initially designated to be eligible for intensive care. Moreover, the patient's survival at 6 months seems to be correlated with the anticipated level of care recorded on the FAD (p<0,0001).

Since 2017, the acceptance of ADF increased and is now integrated into the electronic medical record. All physicians can complete and modify the patient's ADF at any stage of the patient's disease course.

Progress in cancer therapies resulted in a large number of patients receiving outpatients care. There has been a significant increase in patients presenting acute onset symptoms. Which led them to emergency department (ED) without visiting their general practitioner (GP). Our purpose was to identify potentially avoidable ED visits from patients with lung cancer in a comprehensive cancer center.

We retrospectively reviewed the electronic charts of lung cancer patients who consecutively visited ED. Three emergency clinician (EC) working in the ED and 6 GPs subjectively appropriateness of ED visits by analyzing the clinical chart the day of the visit. The concordance between the evaluators was evaluated by calculating the kappa for more than 2 evaluators proposed by Fleiss (1981)

We identified 843 visits for 408 patients: median age (years): 63 [54] [55] [56] [57] [58] [59] [60] [61] [62] [63] [64] [65] [66] [67] [68] [69] [70] . The 4 most common symptoms were pain (16.2%), general weakness (12.3%), dyspnea (12.2%), and fever (11.3%). The ED visits were considered by each EC as avoidable in 32.4%; 32.6% and 24.8% (kappa 0.55 between EC) and by the GP in 52.8% (kappa 0.23 between EC and GP). According to patients burden avoidable unplanned hospitalization was rare (4.8%), 59.2% of them were admitted in inpatients units.

The concordance between physicians for appropriateness ED referral is weak which shows the difficulty to make the decision to refer to ED and the need of well-defined prognostic clinical criteria.

Older patients with cancer are underrepresented in trials investigating the effect of exercise. The aim of this systematic review was to investigate the effect of exercise therapy during medical antineoplastic treatment in older patients (≥ 65 years) with cancer.

A systematic review following the Cochrane guidelines was performed. Randomized controlled trials were identified through a systematic literature search in MEDLINE, EMBASE, CENTRAL, and CINAHL up to December 2019.

Four randomized controlled trials published between 2014 and 2019 were included comprising a total of 412 participants. Most participants were diagnosed with breast, prostate or colorectal cancer. The studies were characterized by large differences in design, interventions and outcomes, which prevented meta-analyses. The interventions ranged from 4 weeks to 12 months and involved both supervised and unsupervised programs. Beneficial effects from mixed interventions (aerobic and resistance exercises) were documented on physical function and physical activity, while a speed-feedback intervention on bicycle ergometers improved cognitive function. No effects were found for body composition, aerobic capacity or for any clinical outcomes. No adverse events were reported. Conclusions Exercise therapy was safe and feasible in older patients with cancer. However, due to a limited number of studies, small sample sizes and heterogeneity across study design, there is only limited evidence of effects of exercise among older patients with cancer during medical antineoplastic treatment.

Several risk factors of systemic outcomes are being investigated in patients undergoing allogeneic hematopoietic stem cell transplantation (alloHSCT), the expression and role of the Herpesviridae family could be associated with systemic and oral complications. Methods Samples of 3 oral sites (oral mucosa, supragingival and subgingival) from 31 patients were collected longitudinally on 5 timestands of alloHSCT. The samples were processed by polymerase chain reaction (PCR) and subsequent enzymatic digestion for Herpesviridae family.

The presence of each herpesvirus in oral cavity was observed in 2.09%, 4.0%, 4.38%, 4.76%, 17.52% e 57.71% for HHV-6A, HHV-6B, CMV, HSV-1, EBV and HHV-7, respectively. The oral shedding of herpes virus was uncommon after alloHSCT, except for HHV-7. There was statistically significant relationship between oral shedding of EBV and CMV at aplasia and acute graft versus host disease. The results suggested that the presence of HSV-1 at the engraftment was related with the relapse. 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. The oral shedding of HHV-7 at aplasia was significantly higher in patients who developed oral mucositis.

Anemia in cancer patients is common with negative impact on quality of life (QoL) and prognosis. The pathogenesis is complex and multifactorial, with iron deficiency (ID) being a major contributor and potentially treatable with iron replacement. All patients should undertake an initial study on their iron kinetics and be evaluated during the course of treatments. Methods Retrospective and comprehensive study including 100 patients aged 40-88 years with solid tumors, that received chemotherapy (ChT) during 1 week of September at an oncology day-care unit at a hospital in Portugal. Data was obtained from patients' clinical process and analyzed by SPSSv25 Results 56% female; mean age 69±12 years. The most common cancer type was breast cancer(32%), colorectal(32%), prostate(8%), and others. 56% had anemia (mean haemoglobin: 10.9±1.1 g/dL), 79%: low grade anemia. None presented severe anemia. 7%: had the treatment postponed due to toxicity. Most patients in the anemic group(77%): stage IV, 39% having colorectal cancer. Of the 77%, 45% underwent an iron kinetics study and iron supplementation was given in 43% (34% orally, 9% intravenous (iv)). Conclusions Anemia is frequent in cancer patients, especially in those with gastrointestinal tumors, advanced stages and receiving ChT but, it often remains an overlooked and undertreated condition. Iv iron seems more effective in gastrointestinal patients. This study will suggest a protocol for screening Introduction Trabectedin was approved for the treatment of adult patients with advanced-stage soft tissue sarcomas.The purpose of this study was to comprehensively review available data on the safety and effectiveness of trabectedin use at Qatar Methods All patients who received trabectedin between November 1, 2015, and March 1, 2018, were reviewed. We evaluated the safety and effectiveness of trabectedin use. A total of 7 patients were identified. 3 of them didn't receive it due to a lack of financial support Results 1 patient received trabectedin for non-approved indications; metastatic ovarian cancer stage IV. And 3 patients received it as indicated for metastatic leiomyosarcoma & metastatic rhabdomyosarcoma. 1 patient stopped the medication after one cycle due to an increase in CEA 125 and transient hepatic toxicity, the next one had disease progression and developed a 12 % reduction in LVEF after 12 cycles, the third patient deceased, had disease progression after the 10th cycle that was received through peripheral line which resulted in extravasation and left arm cellulitis requiring debridement, The last one shifted to another line due to disease progression. All four patients had baseline ECHO and CPK, but no follow-up monitoring (table 1) . Conclusions Utilizing Trabectedin as indicated and performing the appropriate monitoring parameters can achieve maximum benefit with a manageable safety profile. Should be administered only through a central line, monitor LVEF every 2-3 months and CPK and LFTs levels prior to each administration of trabectedin

A. Petranović 1 , P. Podolski 2 , M.Ploh 3 , I. Lovasić 4 , D. Petranović 5 Introduction Previous data in literature indicates a large number of cancer patients exhibiting signs of cognitive impairment at the time of diagnosis, during treatment or many years after successful treatment. We present the results of our research in measuring the cognitive function in patients as well as a review of other risk factors for cognitive impairment in these patients.

Using a Complex Reactiometar Drenovac, we measured cognitive functions in 200 newly diagnosed, therapy naive oncological-hematological patients (grouped by type of the tumour). In our research we used the following tests: test of convergent thinking, spatial visualization, visual orientation, learning and memory, operative thinking, reaction on sound and test of reaction on light.

Anemia and age were proven to be the most significant factors associated with cognitive dysfunction (p <0.001) but other reasons as well as renal dysfunction, sleep deprivation, dehydration, certain laboratory parameters, and certain drugs (chemotherapy, corticosteroids, analgesic, sedative) could influence cognitive functions too.

It is necessary to be aware of cognitive impairment in cancer patients. Early recognition and correction of some reversible factors (anemia, dehydration, choice of therapy etc.) could significantly improve patients cognition and by this also improve their QoL.

Differentiated thyroid cancer (DTC) is the most common form of malignant thyroid tumor. In refractory forms, Sorafenib and Doxorubicin are authorized, with little determining results. The recent approval of Lenvatinib opens a new horizon in its treatment.

Retrospective descriptive study of patients treated with Lenvatinib from September 2018 to September 2019. The information was obtained from the medical records and the outpatient dispensing program (Dominion®). The response was defined based on two RECIST 1.1 criteria. Safety was evaluated based on adverse events (AE) associated with treatment and discontinuation due to it.

All patients had papillary DTC refractory to RAI in stage four. Everyone required dose reduction due to adverse reactions and the average duration of treatment was 9.6 months. A partial response was achieved in 2 of the patients and another presented stable disease. A rectorrhagia was recorded in 1 patient, that required admission. Another patient required treatment discontinuation due to an AHT crisis and bloody diarrea. The third patient presented a palmoplantar erythrodysesthesia that significantly interfered with his daily and work activity.

Lenvatinib has proven to be an effective drug in the treatment of DTC. However, the results are inconclusive because of the sample's shortage. In terms of security, a high number of AE have been observed.Tracking and monitoring AE would be crucial to improve the patients' quality of life.

Uncontrolled symptoms for cancer patients persist despite interventions to alleviate them. Lung & head/neck cancer patients require special attention to treat mouth sores and subsequent dehydration as they frequent emergency rooms. Study's purpose determined the feasibility of a telephone intervention to impact mucositis symptom severity and prevent dehydration in patients receiving chemoradiation; therefore reducing overall symptom severity and improving QoL. The intervention included symptom management education followed by twice-weekly tailored nurse coaching telephone calls. Methods A 2-phase, qualitatively-driven, mixed-methods descriptive design was used to determine the feasibility and effect of the intervention. Eleven participants were recruited with nine completing the study.

Participants found the intervention acceptable; mucositis symptom severity was minimized and dehydration avoided. The intervention minimized overall symptom severity, enabled symptom self-management and improved perceived self-efficacy. The intervention group had no unscheduled medical visits for dehydration vs. a 40% rate in a comparative Retrospective Control Group.

This pilot study is the first to prevent dehydration via non-automated telephone counseling. Potential impact on health outcomes and emotional support provided was crucial in helping patients endure their treatment. This exemplifies significant differences in nurse-care from automated symptom management systems. A larger, more extensive study is indicated.

A. Sahu 1 , C. Russell 1 , J. Torres 1 1 Goulburn Valley Health, Oncology, Shepparton/Victoria, Australia Venous thromboembolism (VTE) is a common complication of cancer. To date, several scores for predicting the risk of VTE in patients with cancer have been developed. These include the Khorana, CONKO, and PROTECHT scores. This was a retrospective audit of 108 ambulatory oncology patients who developed VTE after starting chemotherapy. Data pertaining to patient, cancer, and treatment-related risk factors were collected. VTE risk scores were calculated and correlated with different risk factors and time to thromboembolic event (TTE) . The majority of VTEs were DVTs (54.7%) with proximally located being 85.2%. VTE were more likely to occur within the first year after commencing chemotherapy (69.4%), being more common in the first 6 months/180 days (48.1%). Nearly all VTEs occurred within 3 years (~89.8%). The shortest TTE was 8 days, with a median of 183.5 days. 83.3% of the events had been classified as low to intermediate risk (Khorana score 0 -2), while only 16.7% were high risk (3+). The Khorana score displayed poor sensitivity, predicting only 14.8% of VTEs. The PROTECHT score showed the best sensitivity (38.0%) of the scores tested. There was association between different ECOG performance statuses and time to thromboembolic event -with poorer performance status (i.e: higher ECOG score) correlating with a shorter TTE. Conclusion -None of the VTE scores have sufficient sensitivity to represent an ideal risk stratification tool for prescribing prophylaxis. While its sensitivity remains low, the Khorana score represents the best tool for risk stratification in cancer.

There is no published validated questionnaire to capture the experience of patient involvement in clinical trials. Our objective is to develop the Patient Reported Experience Measure for Experimental Cancer Medicine (PREM-ECM).

The study is mixed-methods consisting of four stages Stage I: item generation using interviews and focus groups (n=34) Stage II: item refining and questionnaire layout using cognitive interviewing techniques (n=5) Stage III: Item reduction and refinement using cross-sectional study to administer the 'draft item-list' (~300) Stage IV: pilot test the final PREM-ECM (~20-25 patients) Results Stages I and II have been completed In stage I participants recommended the development of two questionnaires: 1) covers experiences of trial introduction/screening/consenting and 2) covers ongoing trial experience. Themes identified included: • Hope • Confidence to decline participation or come-off trial • Shared decision making • Being kept informed • Trial Burden • Fear of disclosing side-effects • Emotional support for self/family/friends Both draft questionnaires from stage III have been completed (n=162 for each questionnaire) and are currently being analysed.

The PREM-ECM will be the first validated experience measure for cancer clinical trials. We anticipate study completion June 2021. Based on patients' suggestions we have developed a draft experience measure for carers/family/friends.

Anemia appears very frequently in patients with solid tumors, affecting the quality of life, survival, and response to treatments. It is known that 70% of patients have anemia during their disease, in most cases it will be multifactorial, being an underdiagnosed and undertreated condition. Intravenous iron therapy is also an underused therapy in these patients.

Retrospective cohort study assessing the results of treating anemia with intravenous ferric carboxymaltose in 254 patients with solid tumors in our hospital between 2017 and 2019 (Table 1) . Absolute iron deficiency was defined as IST < 20% and ferritin < 100 ng/ml, and functional iron deficiency as IST < 20% with normal ferritin.

In our study we found that digestive tumors were the most likely to develop ferropenic anemia. The mean level ± SD of hemoglobin at diagnosis was 11.59 ± 1.85 g/dl. The mean value ± SD of hemoglobin in the treated episode of anemia was 9.16 ± 1.22 g/dl, associated with the following values: ferritin 267 (15-1739) μg/ml, IST 12.45 ± 15.45%. We measured the hemoglobin levels one month after intravenous ferric carboxymaltose treatment finding an improvement of 1.87 g/dl. 72% of anemia episodes did not require blood transfusion and 13 patients received erythropoiesisstimulating agents.

Ferric carboxymaltose is an effective and safe treatment for patients with solid tumors who meet criteria for iron deficiency and anemia. Correcting the iron deficit improves the hemoglobin levels, decreases blood transfusional needs and prevents treatment delays.

Adjuvant trastuzumab (T) has improved the outcome of patients (pts) with HER2-positive early breast cancer (HER2+ EBC). The subcutaneous (SC) formulation has proved to be noninferior to endovenous (EV) with respect to pharmacokinetics and efficacy. Safety profile is similar, with exception to injection site reactions (ISRs). Body mass index (BMI) can be related with ISRs.

The purpose of this retrospective analysis is to evaluate safety profile of SC T in pts with HER2+ EBC. Main endpoints were description of local ISRs assessed by NCI CTCAE version 5.0 and impact of BMI.

Between 2016 and 2019, we included 126 pts, with median age 54years (28-80y). Almost all (n=124, 98.4%) had ECOG PS 0-1. Most pts (n=72, 57%) had a BMI ≥ 25. The median duration of SC T exposure was 10.5 months. Half of pts (n=64, 50.7%) were treated in the neoadjuvant setting with chemotherapy, pertuzumab and EV T. Patient preference was the main reason to consider EV or SC route. Pts were reevaluated 1hour after SC administration. ISRs were reported in 15.1% of pts (n=19), most common injection-site pain (n=13, 10.3%) and erythema (n=10, 7.9%). All were mild or moderate (grade 1-2). There was no difference between ISRs in pts with BMI<25 and BMI≥25 (14.8% vs 15.3%, p=0.452).

Our results showed a safety profile of SC T consistent with previous studies. These data are of major relevance in current pandemic context, suggesting that reevaluation period can be omitted. Moreover our analysis did not show a significant impact of BMI on ISRs in HER2+ EBC pts treated with SC T.

During extensive and long-lasting treatment, children with cancer often undergo needle-related minor procedures (i.e. venapunctures, venous cannulation and puncture of central venous access ports). The use of local anesthetics before these procedures can reduce needle-related pain. There is, however, uncertainty about the type of local anesthetic that should be used. Therefore, a clinical practice guideline (CPG) was developed to establish an overview and provide recommendations for clinical practice. Methods A systematic literature review was performed. The GRADE methodology was used to assess, extract and summarize the evidence. A comprehensive multidisciplinary panel was assembled, comprising 16 professionals and patients representatives. An in-person meeting was held to discuss evidence, complete an evidence-to-decision framework and formulate recommendations. Results Ten randomized controlled trials comprising 1808 children formed the evidence base for the recommendations. We recommend the use of EMLA in children who need to undergo a minor needle-related procedure (strong recommendation, very low quality evidence). Moreover, we suggest the use of tetracaine-containing creams only when rapid cannulation or puncture (within 30-60 minutes) is required (weak recommendation, very low quality evidence).

An evidence-based approach was used to provide recommendations regarding the choice of local anesthetic for procedural pain in children. With these recommendations we aim to reduce procedural pain and contribute to improving care for children.

Estimates show that breast cancer, the leading cause of cancer death in females worldwide, will continue to increase in incidence, highlighting the need for increased treatment capacity. While postoperative radiation therapy (RT) is commonly used to reduce recurrence and mortality, research has shown that moderately hypofractionated radiation therapy (HFRT) and 5-fraction HFRT, are equally safe and effective and can reduce treatment costs. This study aimed to compare the cost of conventional RT (50Gy/25), moderately HFRT (40.05Gy/15), and 5-fraction HFRT (26Gy/5) for breast cancer patients in Brazil.

The cost of each RT regimen was calculated using the International Atomic Energy Agency's Radiotherapy Cost Estimator Tool. The potential annual savings were then estimated by applying the cost of each regime to the 2020 Brazilian cancer incidence rates.

The average costs per patient for 25 fractions, 15 fractions, and 5 fractions are $2,699.20, $1,711.98, and $929.81, respectively. The annual cost savings associated with treating 70% of patients with 15 fraction HFRT and 30% of patients with 5 fraction HFRT as compared to treating all patients with 25 fraction RT is $72,929,315.40. The estimated annual productivity of 1 LINAC machine for 25 fractions, 15 fractions, and 5 fractions is 338, 647, and 1,310 patients, respectively.

The reduced cost and treatment time associated with adopting HFRT can increase RT access and treatment capacity, especially for overburdened health systems.

Cancer patients (pts) often receive oncologic therapies even in the last period of life, when they're more likely to experience hospitalization due to toxicity, clinical worsening, concomitant infections, mainly after an emergency room (ER) admission. They often access palliative care (PC) programs very late or never. Aim of the present work is to identify a pattern of frailty in advanced stage cancer pts.

In this retrospective observational study, a total of 1210 pts were included, hospitalized in the oncology ward of our Institution between Aug 2017 and Jul 2020, after an ER admission. Clinical data were collected regarding histology, date of diagnosis, sites of metastasis (mts), comorbidities, diagnostic/therapeutic procedures in last 90 days (L90d), oncologic therapy lines (CT), radiotherapy (RT), date of last CT/RT, CT schedule, research protocols, previous ER visits and admissions for supportive care (SC).

Based on outcomes, pts were classified into 2 classes of frailty: lessfragile (LF) and more-fragile (MF) pts. LF pts are those discharged in ordinary mode, resuming their previous program. MF pts are those who accessed a PC program or died during the hospitalization. We identified a fragility pattern: age ≥65 yrs, visceral mts, CT or RT for advanced stage, >1 hospitalization for SC in disease history and in L90d, >1 access to the ER in L90d for a visit.

This fragility profile may help oncologists to offer a PC program to advanced stage pts timely and prevent ER accesses and hospital admissions close to the end of life.

Prostate cancer patients experience various cancer-and treatmentrelated symptoms that negatively impact the Quality of Life (QoL) of the patients and caregivers. This study aimed to identify distinct patient subgroups based on their symptom experiences; examine how their demographic and cancer characteristics affected the subgroup clustering; and assess the QOL of patients in the subgroups and their caregivers.

We analyzed the baseline data of 263 patient-caregiver dyads in a randomized clinical trial. We used Latent Class Analysis to identify patient subgroups based on the prevalence of 16 common symptoms and examined the influence of their' demographics and cancer characteristics on the clustering. We used the BCH method to examine the QoL (i.e., SF-12 and FACT-G) of patients in different subgroups and their caregivers.

The optimal model included 3 patient subgroups. Patients' race (p<0.05), income (p<0.05), and education (p<0.05) affected the clustering. Patients in subgroups with lower prevalence of symptoms had better QoL (ps<0.05). The social (p<0.05) and emotional well-being (p<0.05) and mental component score (p<0.05) differed among caregivers of patients in different subgroups.

Prevalence of symptoms varied among prostate cancer patients. Identifying subgroups of patients with varying symptoms and demographics can help develop tailored symptom management interventions to improve QoL of both patients and caregivers. 

Early involvement of a supportive care team (SCT) and timely symptom management guided by a patient's self-report of symptoms has been shown to improve symptom control, quality of life and prolongs surviv-al1. The goal of our study is to evaluate the model of a direct collaboration between the Multidisciplinary Tumor Board (MTB) and the SCT at the moment of a patient presentation to the MTB at the IORS.

Patients with advanced cancer reporting symptoms when presented to the MTB were directly referred to the SCT at the day of presentation. The period from November 2018 to December 2020 is analysed here. The Edmonton Symptom Assessment System (ESAS) was used to assess the symptom burden, and the severity of symptoms was evaluated initially and after the SCT intervention.

The ESAS records were collected from 100 patients (Table 1 ). Moderate to severe pain and fatigue were the most frequently reported symptoms (85%, 62%, respectively). In addition, 74% of patients reported that their wellbeing was moderately-severely impaired ( Figure 1 ). After seven days clinically meaningful (≤30%) pain relief and improvement of overall well-being was reported in 70% (56/80), and 65% (52/80) of patients, respectively.

Pain was the most frequent referring symptom. The direct collaboration between the MTB and the SCT helped to better characterize symptom burden in the referred patients with advanced cancer as well as to provide timely symptom management at the moment of presentation to the MTB.

Complementary and alternative medicine (CAM) is an emerging concept in the therapeutic approach of patients with cancer.We chose to describe the prevalence of the CAM in patients with breast cancer and to analyze their profiles , the reasons behind the use of CAM and the doctor-patient relationship. Methods A descriptive transversal study was conducted in the Institute of Salah Azaiez in Tunis collaging patients with breast cancer and with a followup period of 5 weeks from February 2019 to March 2019.Female patients with localized or metastatic breast cancer underwent a questionnaire including the sociodemographic characteristics ,their history, current stage of cancer and received treatments especially non-medicinal therapies as defined by the National center for complementary and integrative health 2012. Results 227 female patients were included. The prevalence of use of CAM was 80%.Among those patients,68% believed that CAM is a way to strengthen the immune system.60 % considered it as main curative treatment for cancer itself. The most used methods were phytotherapy (24%) and nutritional therapy (22%). 42% were satisfied with the results and most of them (85%) did not announce the use of MCA to their doctor. 63% of patients were not questioned by their doctors about the use of CAM.

CAM is a common practice in patients with cancer.Further investigations must be held in order to study the place of CAM and its impact on the health of patients with cancer in order to avoid potential side effects that can be dangerous. Opioid-induced constipation (OIC) is the most common side effect of opioids. Guidelines recommend routine prescription of a laxative for preventing OIC in all patients unless a contraindication exists. We determined patterns of laxative prescription in patients with lung cancer initiating opioids.

We performed a retrospective cohort study evaluating the prescription of laxatives for OIC to adult patients with incident lung cancer in the Veteran's Affairs system, between January 1, 2003, and December 31, 2016 . Exposure to laxative agents was categorized as: none, docusate monotherapy, docusate plus another laxative, and other laxatives only. Prevalence of OIC prophylaxis was analyzed using descriptive statistics. Linear regression was performed to identify time trends in the prescription of OIC prophylaxis.

Overall, 130,990 individuals were included in the analysis. Of these, 87% of patients received inadequate prophylaxis (75% no prophylaxis, 12% docusate alone), while 5% received OIC prophylaxis with the unnecessary addition of docusate to another laxative. Through the study period, laxative prescription significantly decreased, while other categories were unchanged. We noted an inverse relationship with OIC prophylaxis and a diagnosis of constipation at 3 and 6 months.

In this study of veterans with lung cancer, almost 90% received inadequate/ inappropriate OIC prophylaxis. Efforts to educate physicians and patients to promote appropriate OIC prophylaxis in combination with systems-level changes are warranted. 

The COVID-19 pandemic is the major global health catastrophe and an extreme challenge since World War II. The aim of the study is to analyze the patient's satisfaction regarding the telemedicine experience in comparison to the face to face clinics even after the pandemic times with respect to the palliative care services.

We surveyed 104 participants who attended the palliative telephone clinic and explored their experience and the efficacy of telemedicine compared to the face to face physician consultations. The survey was conducted by the palliative care physicians and clinical nurse specialists.

In the survey 69 (67%) patients said telephone clinic was convenient and effective. 95 (91%) patients answered time allotted for the clinic was sufficient. 96 (92%) of patients were satisfied with the phone clinics. When given the options in telephone clinic, 77 (74%) patients opted for phone clinics. 97 (93%) patients received the medications on time. 63 (61%) wanted a mix of both face to face and phone clinics even after the pandemic. 83% of the participants said they would recommend the telemedicine to the concerned health authorities. The open-ended question had most of the responses (above 80%) to be positive feeling regarding the telemedicine consultation and the palliative care services.

Most of our patients are satisfied and prefer a mix of face to face and phone clinics even after COVID 19. Future of medicine should consider a significant space for the telemedicine across all specialties.

Continuous subcutaneous infusions (CSCI) are used by palliative care to administer multiple drugs optimising symptom control. Current practice denotes that a CSCI infuses over 24 hours. Anecdotal reports highlight 48-hour CSCI's being used effectively in a community palliative care setting, resulting in increased service efficiency. Review of the literature reveals a scarcity of data pertaining to the effectiveness and safety profile of 48-hour CSCI utilisation. Methods As part of a quality improvement initiative, a review of 48-hour CSCI usage by a community palliative care team over an 18 month period was carried out retrospectively. Data collection included medications used, reported complications and patient demographics. Results 36 patients prescribed 48-hour CSCI's were identified and included for analysis. The majority had a malignant diagnosis (n=29). Reason for commencement of a CSCI was end of life care (n=22) or symptom control (n=14). Mean duration of 48-hour CSCI was 7.5 days; 16 patients died on a 48-hour CSCI. Levomepromazine was the most commonly used medication (n=31) followed by midazolam (n=29). Morphine sulphate was prescribed in 69% of cases (n=25), oxycodone in 25% (n=9) while 6% contained no opioid. Dexamethasone 0.5mg was added to 97% of infusions. Zero drug interactions were reported. All 48-hour CSCI prescriptions included at least 2 medications, with 55% containing 4 drugs.

These results confirm that 48-hour CSCI's have been used safely and effectively to administer medications in a community palliative care setting.

Current guidelines recommend initiation of palliative care within 8 weeks of cancer diagnosis. 1 In low-middle income economies such as India, palliative care is evolving and predominantly focuses on pain and end-oflife care. 2 Sarcopenia, reduced functional capacity and fatigue are known to significantly affect quality of life, but data on their prevalence is limited in LMICs such as India.

To fill this gap, a functional outcomes registry is being developed at our institute. A data capture template using WHO's ICF Framework was developed and piloted before implementing in clinical practice. The present analysis is based on initial assessment of adult patients admitted for primary chemoradiotherapy for solid tumours between May-August 2019. EWGSOP2 guidelines was used for diagnosis of sarcopenia using hand grip strength; fatigue was assessed using Fatigue Questionnaire (Physical); and 6MWD using ATS guidelines Results Two hundred and fifty-three unique patients (age:51±13 years; 61% females) were assessed by trained physiotherapists. Cancer of HNC, breast, cervix & uteri and GI system accounted for 65% of all cancer in this cohort. Using the EWGSOP2 cut-off scores, 94% males and 55% females had probable sarcopenia. The mean 6MWD was 345 ± 64 meters and 48% participants reported more than usual or severe fatigues.

There is significant burden of sarcopenia, reduced functional capacity and fatigue; suggesting the need for appropriate supportive care interventions such as nutrition and exercise interventions in this setting.

At the Cross Cancer Institute (CCI), patients requiring consultation for palliative radiotherapy (PRT) can be assessed in multiple settings, including through a dedicated multidisciplinary Palliative Radiation Oncology (PRO) clinic. We describe comprehensive needs assessment by setting of PRT consultation. Methods This analysis of routinely collected data examined female patients with breast cancer who died between 2013 and 2014, and had at least one PRT consultation. Referrals to allied health professionals (AHP) and specialist palliative care (SPC), and setting of PRT consultation, were at the attending physicians' discretion. Data abstracted included Karnofsky performance status (KPS) and Edmonton Symptom Assessment System (ESAS) ratings.

Of 130 patients, 9 did not have PRT, 65 had one course, and 56 had two or more. 28/224 (12.5%) total PRT consults took place in the PRO clinic. KPS was documented in 30.1% vs. 89.3%; medication history in 53.6% vs. 96.4%; and symptom-directed medications in 47.4% vs. 96.4% of non-PRO vs. PRO visits, respectively (all p<0.0001). Baseline and follow-up ESAS scores were available for 67.9% and 35.7% of PRO visits, respectively, and not available for any non-PRO visit. PRO consults had a higher proportion of subsequent AHP referrals (50% versus 8.2%; p<0.0001). Conclusions Assessment for PRT by a dedicated multidisciplinary team provides a comprehensive picture of overall function and symptom burden. The resulting ability to tailor supportive care referrals is essential to personalization of end-of-life care.

Tumour bleeding is a frequent complication in advanced cancer patients that could affect the prognosis and quality of life. Haemostatic radiotherapy (HRT) can achieve adequate symptom relief in these patients, but the optimal radiation schedule is yet unclear. We aim to evaluate the rate of bleeding control (BC) between single HRT and multi-fraction HRT in palliative care cancer patients.

We reviewed 78 patients treated from 2015 to 2020 at our institution with bleeding tumours, with a median follow-up of 60 days. We analyzed the BC rate within 15 days from HRT. Chi-square test was used for analyze differences in BC between groups.

The median age was 72 years (40-95), 55 male patients (70.5%), ECOG performance status ≥3 43 (55.2%). The most common schedules were 1x6 Gy (44.9%), 5x4 Gy (15.4%), 2x6 Gy (15.4%) and 1x8 Gy (10.3%). The most frequent locations were genitourinary (38.5%) and gastrointestinal (34.6%). The overall rate of BC in the first 15 days was 66.7% (28/42) and 63.9% (23/36) for single-dose versus multi-fraction HRT (p= 0.834), respectively.

In terminal cancer patients, symptomatic care must avoid over treatment procedures. In our cohort, single dose HRT has proven to be as effective as multi-fractionated HRT to control tumour bleeding. We consider that in the context of end of life palliative care, a single-dose fraction is a better option for short-term symptom relief.

Malignant bowel obstruction (MBO) is a highly distressing complication of cancer, particularly affecting those with advanced ovarian/ gastrointestinal cancers. There is limited research into experiences of healthcare professionals (HCPs) managing patients with MBO. Methods Semi-structured interviews undertaken with HCPs involved in the management of MBO. Thematic analysis was the analysis method.

Nineteen interviews, with nine palliative care, five oncologists, two surgeons, and three dieticians. Analysis highlighted complexities of caring for, and deciding on, goals of care for these patients, given the extremity and range of physical symptoms and psychosocial responses with MBO. Symptoms of highest priority to address were abdominal pain, vomiting and nausea. Additionally, issues of oral intake were a highly complex problem. Each individual case was described as variable, with many factors impacting decisions. Multidisciplinary approaches were essential for managing patients, particularly inoperable and complex patients (underlying disease, comorbidities). The use of guidelines for managing patients with MBO was described with a level of ambiguity and lack of specificity. Conclusions MBO is a highly complex, distressing consequence of advanced cancer. Each patient is variable and face unique challenges. Specific assessments/ guidelines are lacking or non-specific; however, the diversity and complexity of cases suggests that generating specific guidelines is a challenge in itself.

Malignant bowel obstruction (MBO) is a challenging complication of advanced cancer, for patients, family carers, and healthcare professionals to experience/manage. Commonly used outcome measures do not reflect what is important to patients. This review aimed to identify views and experiences of MBO to inform future outcome measures. Methods Rapid review of qualitative literature using Palliative Care Evidence Review Service modified systematic review methodology. Medline, Embase, PsycINFO, Cinahl, Scopus and grey literature were searched and analysed using thematic synthesis.

Nine papers included, relating to patients (7), family carers (2) and/or professionals (3). Studies reported interventions (3), patient experience (4), and processes of care (2) . Despite varied areas of focus, similar topics emerged, such as symptom burden and consequential, far-reaching impacts (psychosocial, quality of life). The nature of MBO was identified as uniquely distressing. Communication was a key barrier or facilitator of effective care. Decision-making was complex, with each treatment having its' challenges when deciding goals of care.

Despite challenges recruiting patients/carers to interview at end-of-life, these studies demonstrate gathering their perspectives is necessary. Despite limited evidence on MBO experiences, this review highlighted outcomes not identified in quantitative research; however, further research is vital given complex symptom management and psychosocial impact of the condition.

Inoperable malignant bowel obstruction (IMBO) is a challenging condition to manage, and there is a lack of consistency in outcome measures used in its assessment. This review aimed to identify outcomes measured in research as part of a study developing a core outcome set for the assessment of IMBO.

The review followed PRISMA guidelines and the COMET protocol (PROSPERO ID: CRD42019150648). Searches were conducted in Medline, Embase, the Cochrane Database, CINAHL Caresearch, Open Grey and BASE for RCTs, quasi RCTs, single-arm trials and observational studies assessing patients with IMBO; reference lists of reviews were handsearched. Outcomes and definitions were extracted verbatim and categorised into thematic domains. Results 4,209 studies were screened, 265 full text articles retrieved, and 81 studies included in the synthesis; 336 verbatim outcomes were extracted and pooled into 90 unique terms. The most prevalent outcomes were survival (53% of studies), symptom control (42%), mortality (35%), complications (32%), vomiting (31%), length of hospital stay (24%) technical/ procedural success (24%), oral intake (23%) and measures related to the use of nasogastric tubes (23%); 15% of studies measured health-related quality of life. Definitions of clinical success varied.

The review identified inconsistencies in outcome definitions and endpoints. Few studies measured psychological wellbeing; RCTs reported difficulties in measuring quality of life. The development of a patientrelevant core outcome set for IMBO can address these issues. Table _Page Response to treatment (9) -9 --Symptom distress (10) 1 9 --Separate measures reported for key symptoms: 

Pain (12) 4 8 - - Nausea (13) 4 9 - - VomiƟng (25) 4 21 - - Secondary symptoms: Anorexia (2) - 2 - - Abdominal distenƟon (2) 1 1 - - Drowsiness (1) - 1 - - Dry mouth (1) - 1 - - FaƟgue(2) - 2 - - SensaƟon of thirst (1) - 1 - -

Naldemedine is a peripherally acting μ-opioid receptor antagonist for the management of opioid-induced constipation (OIC). This study aimed to assess the efficacy and safety of naldemedine in cancer patients needing palliative care.

We retrospectively collected and analyzed clinical data of 555 cancer patients who newly started palliative care services between December 2017 and November 2019 at National Hospital Organization Tokyo Medical Center.

Forty-six patients (mean daily dose of opioids (oral morphine-equivalents), 43.3±41.7mg) needed naldemedine. Of these, 41 patients (89.1%) experienced the first bowel movement (BM) within 48 hours after first intake of naldemedine. BM frequency was significantly higher after start of naldemedine compared to before (p<0.0001). Six patients (13%) discontinued naldemedine within 3 days due to adverse events (diarrhea, 5 patients; drug eruption, 1 patient). Thirteen patients (28.3%) required stimulant laxatives in addition to naldemedine before achieving BM. Subgroup analyses were performed for naldemedine monotherapy (Group N) versus combined naldemedine and stimulant laxatives (Group C). Group C showed a non-significant tendency toward being older than Group N. No significant differences were seen in opioid use, BM frequency before taking naldemedine, or duration of opioid administration between Groups N and C.

Naldemedine is useful in the management of OIC among advanced cancer patients, but combination therapy with stimulant laxatives is sometimes required.

Opioids are used for pain management among cancer patients; however, the response to opioids largely differs among individuals, probably owing to polymorphisms in genes regulating opioid metabolism. Methods 68 Korean terminal cancer patients were interviewed and the amount of opioid required to maintain the pain level at VAS≤4 was recorded. Blood was sampled and subjected to genotype analysis for the SNPs OPRM1 A118G and ABCB1 C3435T.

In 68 cases of terminal cancer patients, the allele frequencies of 118G and 3435T were 0.38 and 0.36, respectively, and There was a significant difference among the OPRM A118G genotypes (P=0.048) in the weightsurface area-adjusted-24h-opioid dose and the opioid requirements of patients with ABCB1 3435T allele were significantly lower than those with 3435C allele (P=0.041). Multiple linear regression analysis (R2=36.1%, P=0.00) showed that in the case of OPRM GG homozygote and ABCB1 CC homozygote at the same time, the 24h-opioid dose increased by 816.04 mg/24hr compared to the wild type, and weight-adjusted-24h-opioid dose was increased by 13.44 mg/24hr/kg and weight-surface area-adjusted-24hopioid dose increased by 39.01mg/24hr/(kg/m2).

When OPRM1 GG Homozygous and ABCB1 CC Homozygous coexist, there is a possibility that the opioid requirement is increased more compared to the case when the wild type of the two genes coexist. and the proportions of OPRM1 A118G SNP and ABCB1 C3435T SNP in Korean terminal cancer patients by genotype were similar to those of general Korean population. 

We compared individuals without AC-EOL with those having 1 or >1 indicator. PC timing was divided into none, < 30 days, 30-90 days, and > 90 days. Advance directives (AD) completion dates used the same intervals. Chi Square was used for dichotomous and categorical data, one-way ANOVA for continuous variables. Logistic regression models were used to calculate ORs and confidence intervals; p < 0.05 was statistically significant. Results 1727 patients, 46% female, mean age 69 (SD 11.9) were included. 888 had 1 indicator of AC-EOL. 71% had a PC consult and 26% completed ADs. PC consults within 90 days of death were associated with greater AC-EOL (p=0.04) and were largely crisis oriented (Table 1) . PC consults >90 days before death dramatically reduced AC-EOL (p <0.001). The odds AC-EOL with a PC consult initiated >90 days before death was 0.59 (95% CI: 0.45, 0.78) with 1 indicator and 0.40 (95% CI: 0.32, 0.51) with > 1 indicator. ADs > 90 days before death had a trend toward reducing AC-AOL (p=0.056) Combinations of PC and ADs> 90 days reduced AC-EO (p=0.034; Table 2 ). Discussion PC consults > 90 days before death reduces AC-EOL. ADs completed > 90 days influence AC-EOL. The timing of ADs and PC is a quality metric. Conclusion EPC is PC initiated > 90 days before death.

There is limited data about assessments that predict increased utilization of medical services among advanced oncology patients (AOP). We aimed to identify factors related to PC, HA, AC, ER, and death in AOP.

Medicare & Medicaid Innovation program. Participants completed the Edmonton Symptom Assessment Scale (ESAS) and the Functional Assessment of Cancer Therapy -General (FACT-G) scale. We examined factors associated with PC, HA, AC, ER, and death.

In all, 817 AOP were included in these analyses with a median age of 69. 

The ESAS and FACT-G assessments were linked to PC and AC visits, and death. These assessments may be useful for identifying AOPs that would benefit from routine PC.

Integration of PC remains challenging in CCC due to a variety of barriers. We aimed to understand the perspectives of OHCP at a National Cancer Institute (NCI) designated CCC on the role of PC.

We conducted a cross-sectional survey of physicians, advanced practice providers (APP), nurses, and social workers (SW) regarding the role of PC (outpatient (OUTPT) and inpatient (INPT)) at a NCI-CCC in Northeast Ohio.

We received a response rate of 65% (144/221) with mostly women (78%) and a variety of OHCPphysicians (32%), nurses (32%), APP (17%), and SW (6% 

In correlation with the literature, most symptoms in our analysis, except pain and nausea, appeared much less severe, only loss of appetite more. Likewise, we observe lower overall burden of symptoms. Reason for that could be an early referral that is why our analysis needs additional consideration. 

Delirium is a frequent complication of advanced cancer. AP and BZD are prescribed for hyperactive delirium despite side effects and lack of supportive evidence. VPA improves agitation without QTc prolongation, excessive sedation or parkinsonism. However, high quality evidence for this is lacking.

Retrospective review of inpatients seen by palliative medicine from October 2019 to April 2020 who received VPA for at least 24 hours for the management of agitation due to delirium. We excluded patients who had VPA for seizures or bipolar disorder. Agitation response was categorized as: better, worse or unchanged based on documentation at day 3 and 5 after VPA initiation. We evaluated use of AP and BZD starting 24 hours before initiation and up to 3 days after VPA.

We identified 20 patients. According the report of international agency of cancer research, incidence of cancer disease was 19.3 million and mortality related to that was 10 million people in the worldwide in 2020. Mortality rate related to cancer was about 55000 people in 2018. In fact, 16% of all deaths related to chronic diseases are caused by cancer and the majority of cancer patients expire in the intensive care units (ICU), whereas bed occupancy of ICUs is in crises, being about 100% in Iran. In the current condition, due to the high cost and shortage of nurses in Iran and COVID-19 crises setting up of ICU beds is a challenge for the health system. WHO introduced home-based palliative care to improve the quality of life; quality of death; decrease burnout in staffing; decrease mortality in hospitals; reduce the cost, and release the beds in hospitals. Although hospital beds are considered for healing the patients not a hospice for them, the majority of cancer patients die in the hospital and on the ICU beds. To consider countless benefits of home care and the patients' desire to receive services at home, if we can provide the conditions that at least 20% of end stage cancer patients in receive home based palliative care, 1000 deaths will occur at home yearly, and 1000 ICU beds will be released for use for other patients with better prognosis for survival. Therefore, health system authorities in Iran should considered home-based palliative care of cancer patients as a priority. Keyword: Palliative care; Home-based; Cancer patients; Intensive care units.

S. Hojjat Assari 1 , H. Heydari 1

According to the World Health Organization, palliative care is one of the main components of healthcare. .

This qualitative study was carried out using conventional content analysis from October 2016 to September 2018 in Iran. Participants were home care providers who were selected using purposive sampling. Data were collected through 18 individual interviews, and a focus group meeting. Data were analyzed based on the method proposed by Lundman and Graneheim.

Based on the data analysis, 511 initial codes were extracted, which were categorized into the two main categories of challenges and opportunities for home-based palliative care and 10 subcategories. The subcategories of challenges included deficiencies in intersectoral and inter-professional cooperation, lack of infrastructures for end-of-life care, challenges related to the management of death, challenges of transferring patients to home, providing non-academic palliative care, lack of political commitment of the government and spiritual vacuum. The category of opportunities included the subcategories of cost-effectiveness, moving towards socializing healthcare, and the health system structure.

Home-based palliative care requires government and health system support. Healthcare structural and process modifications can provide conditions in which terminally ill cancer patients receive appropriate care at home and experience a dignified death through the support of family, friends, and healthcare staff.

Despite evidence supporting benefits of early palliative care, at our institute patients are referred to our outpatient clinic for early palliative care (OCEPC) often very late during course of a disease. We decided for proactive approach of early integration and invited patients with shortest 5-year survival according to national cancer registry to OCEPC early from the beginning of anti cancer treatment. We started with patients with metastatic pancreatic and oesophageal cancer from April of 2019. AIM: We propose proactive approach and positive feedback will stimulate oncologist to refer also other patients in need to OCEPC still during cancer directed therapy.

We performed analysis of referrals to OCEPC in 2018-2019 and prepared comparison of acquired data in these two years. Data was obtained through the hospital's electronic record system.

We recorded 82 and 87 first visits to OCEPC in 2018 and 2019 accordingly. Among those 18 (21%) and 34 (39%) patients were referred to OCEPC during cancer directed therapy in 2018 and 2019 accordingly. There was increase in number of patients referred to OCEPC during anti cancer treatment not only for patients with metastatic pancreatic and oesophageal cancer (2% in 2018 and 14% in 2019) but also with other cancer diagnosis (19% in 2018 and 25% in 2019) .

Spreading knowledge of benefits of early integration of palliative care and active involvement of patients with poor prognosis is the right approach to reach patients in need of comprehensive care.

Oral problems are common in patients with advanced cancer, and cause significant morbidity. However, observational studies suggest that oral problems are not well-managed. Therefore, the MASCC Palliative Care Study Group (in conjunction with the Oral Care Study Group) formed a subgroup to develop evidence-based recommendations on the prevention and management of oral problems in patients with advanced cancer. Methods A search strategy for MEDLINE and the Cochrane Library was developed and relevant articles were reviewed. The guidelines are being developed in accordance with the MASCC Guidelines Policy and are being categorised by the level of evidence (i.e. "recommendation", "suggestion", or "no guideline possible"). Currently, there is a provisional draft of the guidelines, which is undergoing internal review / editing (prior to submission to the MASCC Guideline Committee) Results 231 full text articles were reviewed, including 12 Cochrane systematic reviews. The Group has produced 12 provisional generic suggestions (Table 1) , and a number of more specific suggestions / recommendations relating to individual oral problems e.g. xerostomia and oral candidosis. The generic suggestions relate to assessment, oral hygiene (prevention), principles of management, and re-assessment.

These guidelines will provide a framework for the prevention and treatment of oral problems in advanced cancer, although every patient requires individualised assessment and management. 

As Korea is located in an Asian region where values collectivism, the patient-led decision may be challenging because family members play an essential role when making critical treatment decisions. However, The Act on Decisions on Life-Sustaining Treatment for Patients was enacted without this consideration in 2018, Korea. This study aims to explore the end-of-life decision-making process and suggest an appropriate strategy to pursue shared decisions.

The qualitative research was conducted 21 interviews with each of the three stakeholders: patients, medical staff, and family members. The transcribed data were analyzed using Strauss's 6C grounded theory methodology.

The "Central phenomena" was emerged as "enduring alone under the burden." The context reflects the cultural factors of Korea in which moral stance takes precedence. From the family member's perspective, it was an acceptable duty to express that they want the patient to be alive as much as possible with offspring or wife/husband. From the patient's perspective, they were worried about the choices they thought it was socially right or "desirable" rather than deciding by themselves. They want doctors to step forward and provide a timely explanation of the patient's condition.

The results recognized "morality" in the process of advanced directives decision-making in the Eastern region of the clinical field. The attitude of the medical staff will allow them to make autonomous decisions. This study reviewed the first year of determination to life-sustaining treatment through data analysis of the National Agency for Management of Life-Sustaining Treatment (LST).

The National Agency for Management of LST provided data between February 4, 2018 and January 31, 2019 anonymously from 33,549 patients.

The median age of the patient was 73 and the majority was male (59.9%). Cancer patients were 59% and self-determinants were 32.1%. Cancer patients had a higher rate of self-determinants than non-cancer (47.3 % vs 10.1%,). Plan for hospice service was high in cancer patients among self-determinants (81% vs 37.5%, p<0.0001).

In comparison to family-determinants, self-determinants were younger and had more cancer diagnosis. Decision of withholding or withdrawing of LSTs in cancer patients was higher than noncancer patients in four items.

During the first year after the implementation of the LST Decision Act, self-determinants were 32.1%. Cancer patients had a higher rate in self-determination and withholding or withdrawing of LSTs than non-cancer patients. Continued revision of the law and education of the public will be able to promote withdrawing or withholding the futile LSTs in patients at end-of-life. Further study following the revision of the law should be evaluated to change of end-of-life care.

Opioid-induced constipation (OIC) is often underdiagnosed and undertreated in patients with advanced cancer. The authors hypothesised that using a stepwise treatment algorithm and patient reported outcome measures should improve OIC management.

Patients with OIC (Rome Foundation IV diagnostic criteria) and Bowel Function Index (BFI) ≥ 30 were recruited. Patient Assessment of Constipation Quality of Life (PAC-QOL) was completed at baseline and final visits. Participants completed weekly BFI and clinical assessments. Decisions about clinical management were guided by current BFI scores and a stepwise treatment algorithm, developed from international guidelines. Results 100 participants were recruited; 79 completed the study. 57 (72%) were deemed responders to the treatment algorithm; 34 (43%) achieved complete response (BFI <30 on final study visit), 23 (29%) achieved partial response (change in BFI ≥ 12). In complete responders, 73.5% received conventional laxatives, 12% received a peripherally acting mu-opioid receptor antagonist (PAMORA), and 14.5% received conventional laxatives and a PAMORA. There were statistically significant differences in some PAC-QOL between responders and non-responders (worries, physical symptoms, satisfaction subscales).

This feasibility study suggests that regular use of the BFI and a stepwise treatment algorithm results in clinically meaningful improvements. A definitive study should be undertaken, although adjustments will be needed to the methodology to improve participant retention and treatment adherence.

The purpose of this study was to analyze contents from coping enhancement counseling sessions from a nurse-led enhanced supportive care intervention.

The nurse-led coping enhancement counseling applying principles of the self-efficacy theory and the acceptance and commitment therapy were provided. Twelve advanced cancer patients completed five times of study participation. Participants were asked about difficult emotions experienced after diagnosis of advanced cancer, coping strategies utilized, and life values. Intensity of emotions were assessed using numeric rating scale. Contents from each counseling session were analyzed.

Overall, the intensity of difficult emotions decreased over time, although fluctuation of emotion was observed among some participants in relation to family issues, changing health, and hearing information about negative prognosis. Worry was the most frequently reported emotion, followed by anxiety, heart breaking, and regret. Among coping strategies utilized, acceptance was the most frequently utilized coping strategy, followed by emotional support, positive reframing, and active coping. The most frequently mentioned life value was benevolence which was mostly expressed in the context of family relationship.

Difficult emotions were decreased over time with the nurse-led coping enhancement counseling intervention. The results of the study inform future nurse-led coping enhancement counseling for advanced cancer patients. A fully powered randomized controlled trials will be the next step.

To examine feasibility and preliminary efficacy of nurse-led enhanced supportive care focusing on symptom management and coping enhancement for advanced cancer patients.

A pilot study was conducted. Evidence based symptom management was provided through symptom monitoring and according education.

Copings were enhanced through nurse-led counseling applying principles of the self-efficacy theory and the acceptance and commitment therapy. Physical symptoms, anxiety and depression, self-efficacy for coping with cancer and quality of life were measured and analyzed using descriptive statistics and paired t-tests.

A total of 30 advanced cancer patients were enrolled. Enrollment and retention rates were relatively low, whereas, considering characteristics of study participants and inevitable dropouts, the intervention was considered feasible. The nurse-led enhanced supportive care demonstrated medium effect for decreasing physical symptoms, anxiety, and depression. Self-efficacy for coping with cancer especially for maintaining activities and seeking social support, and quality of life especially for global health status/QoL, emotional functioning, and social functioning were improved demonstrating medium effect.

The feasibility of the nurse-led enhanced supportive care intervention was demonstrated. The enhanced supportive care demonstrated medium effect in decreasing symptoms and emotions, and increasing self-efficacy for coping with cancer and quality of life. A fully powered randomized controlled trials will be the next step.

Opioid rotation (OR) is used to decrease patients' cancer-related pain and mitigate opioid-induced adverse effects. There is limited evidence regarding its effect on symptoms and morphine equivalent daily dose (MEDD). The objective of this study was to investigate the effects of OR on pain scores, Edmonton Symptom Assessment Score (ESAS), and morphine equivalent daily dosing (MEDD) in patients with cancer.

This retrospective observational study included 676 patients across 3,373 supportive care visits in a supportive care clinic. OR were identified and analysis compared the pre-rotation visit data with the subsequent postrotation visit data using paired t-tests. Primary endpoints included pain scores, ESAS, and MEDD for OR and these endpoints were compared amongst rotations to morphine, oxycodone, methadone.

Pain scores significantly decreased from 6.25 at the pre-rotation visit to 5.75 following opioid rotation. Of the 217 opioid rotations, 29.74% were successful in reducing patients' pain by either 30% or by 2-points. Only rotations to morphine, oxycodone, and methadone correlated with significant decreases in pain scores. Opioid rotation did not correlate with significant changes in ESAS or MEDD. Only rotations to methadone correlated with a significant reduction in MEDD.

These findings suggest opioid rotation is associated with decreased pain scores without increasing standardized dosing. Of the agents compared, only rotations to methadone correlated with both a significant reduction in pain scores and in MEDD. (4), ill-health (1), withdrawal (1) and loss of contact (1) . Median CRP was higher in those who died or were too unwell than in those who completed followup (p = 0.006). Median CRP in those with stable or improved QoL scores was not different to those who had worsened scores (p=0.26).

Several feasibility issues were identified. Symptom / QoL scores and CRP similar in people with inoperable cancer at diagnosis and age/ gender matched controls. High CRP was not associated with deterioration in symptoms / QoL but was associated with death and study non-completion. Future studies should examine whether raised CRP at diagnosis could trigger referral to specialist palliative care. 

We decided to create an Onco-Palliative Expertise Unit (OPEU), in our Comprehensive Cancer Center (CCC), whose main objective, in addition to the treatment of refractory symptoms, is to allow oncologists, palliative care specialists, patients and relatives to redefine the therapeutic project.

One year after opening, this 10-bed unit has received 251 pts in 314 stays. 53% came from the home. After an average length of stay of 11.6 days, discharge was distributed between return home (41%), a palliative care unit (26%), death (22%) and other oncology units, or hospitals (11%). At the opening, refractory symptoms were the most frequent reason for hospitalization (67% of stays). For the first 6 months period to the second one, discussing the therapeutic project increased from 23% to 34% of the hospitalization causes, showing the appropriation of this unit by the oncologists. On admission, specific cancer treatment was ongoing for 56% of stays. After assessment and multidisciplinary discussion, 49% of them decided to stop chemotherapy. Conversely, the start or resumption of treatment was recommended for 9% of stays without specific treatment on admission.

The OPEU allows a multidisciplinary analysis of the pt's condition on a single unit and leads to a quick and more appropriate therapeutic decision.

Dyspnea is often encountered in terminally ill cancer patients and is attributed to multiple factors. The use of fan-on-face therapy is a nonpharmacologic adjunct treatment for adult cancer patients suffering from dyspnea at the end-of-life.

A meta-analysis of randomized controlled trials on the use of fan-on-face therapy in relieving dyspnea among terminally ill adult cancer patients was performed. A computerized search was done in MEDLINE, NICE, CENTRAL, Science Direct, and Google Scholar for relevant articles.

Other publications were searched, and authors were contacted for additional information. The primary outcome measure was the mean change in dyspnea score, determined by the Modified Borg Scale, Numeric Rating Scale, or Visual Analog Scale. The secondary outcome was the post-intervention mean change in respiratory rate (RR).

Four eligible randomized controlled trials of low to moderate risk of bias employed a total of 139 cancer patients. Fan-on-face therapy was effective in decreasing mean dyspnea scores (standard mean difference = −1.81, 95% confidence interval [CI]: −3.12, −0.50, p < 0.00001, I2 93%) and improving mean change in RR (mean difference = −0.91, 95% CI: −1.68, −0.15; p = 0.001, I2 = 81%) versus control.

Fan-on-face therapy, as an adjunct to standard of care, is effective in alleviating dyspnea among adult cancer patients during the end of life.

Patients with advanced cancer are known to have more disrupted restactivity circadian rhythm than those with earlier stage of cancer.

The aim of this review is to examine and map the existing evidence on the rest-activity circadian rhythm in advanced cancer patients. Methods A comprehensive scoping review was conducted. Arksey and O'Maley framework was used to guide the scoping review. Literature search was done in nine databases: MEDLINE, EMBASE, Psycinfo, CINAHL, British Nursing Index, Cochrane Library, Scopus, Web of Science.

Twenty one articles were included in the review. Advanced cancer patients were more likely to display less rhythmic and weaker rest-activity circadian rhythm, with the prevalence of 31.3-54.9%. Circadian disruption was linked with more physical symptoms (appetite loss, fatigue, pain, dyspnea, sleep disturbance) and psychological symptoms (depression, anxiety). It was also linked with chemotherapy, female gender, and lower quality of life. Restactivity circadian rhythm was also found to be a predictor of survival.

Given the prevalence and the impacts of the rest-activity circadian rhythm in advanced cancer patients, it is necessary to consider this aspect in the patient care.

The Edmonton Symptom Assessment Scale (ESAS) is a validated tool used in patients with varied cancer diagnoses to measure patient symptoms. The present manuscript will review the literature assessing the ability of the ESAS to predict patient related outcomes in breast cancer patients.

A literature search was conducted of Cochrane Central Register of Controlled Trials databases, Ovid MEDLINE, and Embase for English articles that investigated the use of predictive modelling with the ESAS in the breast cancer population.

A total of nine articles were included in this review ( Figure 1 ). Five articles used the ESAS in predictive models to determine patient time to death. ESAS was also used to predict emergency department visits, determine symptoms associated with decreased quality of life, and generate a Health Utility Score. Lack of appetite was the most common ESAS symptom reported (Table 1) .

Included studies support the use of ESAS in predictive models, particularly for predicting survival. Using the ESAS as a predictive tool allows for more accurate time to death predictions, potentially improving symptom management and preventing overtreatment of palliative patients near the end of life.

Palliative care within Intensive Care Units (ICU) benefits decision making, symptom control and end-of-life care. It has shown to reduce length of ICU stay and the use of non-beneficial and unwanted life-sustaining therapies. However, it is often initiated late or not at all. There is increasing evidence behind screening ICU patients using "triggers". The aim of the project was to assess the need for palliative care referral during ICU admission using "Trigger" tools.

Electronic patient record review of cancer patients who died in or within 30 days of discharge from oncology ICU 2016-18. Patients referred to palliative care prior to or during ICU admission were identified. Three sets of palliative care referral "triggers" were applied: one that is being tested locally and two internationally derived tools. The proportion of patients who met any of these triggers during their final ICU admission was calculated. 

Palliative radiotherapy (PRT) is used to relieve the symptomatic burden of metastatic cancer but its impact on quality of life (QoL) in those with cutaneous metastases (CM) is unknown. We aim to assess QoL before and after PRT for the treatment of CM.

We retrospectively analyzed 47 patients ( Fig. 1 ) with 1 or more PRT sessions for CM with before and after PRT Skindex-16 questionnaires (part of routine clinical assessment) for a total of 57 CM treated with PRT. Mean symptom, emotion, function, and overall Skindex-16 scores were compared before and after PRT. CM were grouped as "responder" or "non-responder" based on clinical response of the tumor. A general estimating equations model was used to evaluate additional effects of clinical disease and treatment characteristics (Fig. 3) .

Mean QoL scores improved following PRT for emotion ( . Improvement in QoL was associated with clinical response. Responders and non-responders had similar baseline QoL scores, but responders showed improved QoL at follow-up compared to non-responders (change in mean 11.1 vs. -12.9 respectively).

We report improvement in overall QoL and in the emotion and function QoL domains as measured by the Skindex-16 for those with CM treated with PRT. Referral to a radiation oncologist is recommend in those suffering with CM.

The main purpose of this study was to evaluate the radiotherapy (RT) toxicity patterns in Lung Cancer (LC) patients treated with palliative intent.

This retrospective study was based on electronic health records and was approved by the institutional ethical review board. Background Chronic obstructive pulmonary disease is a devastating, incurable disease, and is the only major worldwide cause of mortality that is increasing in prevalence. These patients experience significant symptom burden that would often benefit from a palliative care. We investigated differences in palliative care between patients with Chronic obstructive pulmonary disease and other illnesses and searched for innovative models of palliative care that may address identified gaps for patients with Chronic obstructive pulmonary disease.

MedLINE and PubMed databases were searched for relevant articles using terms palliative care, chronic obstructive pulmonary disease, and integrat*; additional articles were added through the references.

Compared to cancer patients, Chronic obstructive pulmonary disease patients experience similar symptom burden and have a worse quality of life, but have little access to palliative care. When these patients do receive palliative care, they tend to be referred later than patients with cancer due to disease-, patient-, and provider-related factors. Successfully integrated models introduce palliative care early in the disease trajectory and require education of healthcare professionals and the general public, timely advanced care planning discussions, and increased funding.

Integrated models of palliative care for patients with Chronic obstructive pulmonary disease would address many of the barriers, but cultural shifts in perceptions of palliative care are required before these models can achieve their potential. 

The aim was to clarify the trajectory model of activities of daily living (ADL) and factors related to it in terminal cancer patients using Group-Based Trajectory Modeling (GBTM).

The participants were 306 cancer patients aged 18 years or older who were hospitalized in a palliative care unit and discharged from 2015 to 2019. The evaluation of ADL was performed using the functional independent measure (FIM) total score every two weeks from eight weeks before death to just before death (within two weeks), and the data were collected retrospectively. Potential predictive variables for the trajectory model estimated by GBTM were evaluated using multinomial logistic regression analysis (P<0.05).

Using GBTM, the trajectory of the FIM total score from eight weeks before death to just before death included the following four groups: 1) "No Decline", no decline until just before death; 2) "Rapid Decline", rapidly declined from four weeks before death; 3) "Moderate Disability and Slow Decline", group had moderate disability and declined slowly; 4) "Severe Disability", severe disability from eight weeks before death. Brain metastasis, age over 65 years, and lung metastasis were predictors for the "Severe Disability" group, and their odds ratios were 10. a novel intervention that targets symptomatic patients. The effectiveness of STEP vs. usual oncology care was explored in a randomized controlled trial. Symptomatic patients within the STEP arm received a triggered call by a nurse, offering them a referral to the palliative care clinic, which patients could accept or decline. We explored patients' reasons for accepting/declining this referral.

In this qualitative descriptive study, STEP participants who had received a triggered call were interviewed. Interviews (n=9) were conducted over the phone and ranged from 30-90 minutes. Interviews were transcribed verbatim and the accuracy of the transcripts was verified. Five investigators conducted thematic analysis; themes were discussed until consensus was reached.

The concept of readiness was an overarching theme. Reasons for accepting the referral included: to manage symptoms, to start a therapeutic relationship, and to get support to cope with uncertainties surrounding the future. Reasons for declining included: perceiving symptoms as normal, needing time to process information, feeling adequately supported by caregivers, and fearing the unknown.

Our study revealed several reasons why patients may accept/decline a palliative care referral. This information is important to guide the provision of timely palliative care for those in greatest need.

Cancer induced bone pain (CIBP) can be challenging to manage in advanced cancer. The unique properties of methadone may have a role in refractory CIBP. We aimed to evaluate the analgesic effects of methadone for CIBP when other opioids are ineffective or intolerable.

Retrospective study of palliative care inpatients rotated to methadone from another opioid for CIBP over a 4-year period. Primary outcome was ≥30% reduction in pain intensity (11-point numeric rating scale) from baseline to completion of methadone rotation (MR). Secondary outcomes were ≥50% reduction in pain intensity and changes in longacting and breakthrough opioid requirements.

Ninety-four eligible patients completed MR for the following reasons: poor pain control (72.3%), opioid toxicities (4.3%), or both (23.4%). On completion of MR, 70.2% and 53.2% achieved a ≥30% and ≥50% reduction in pain respectively, with mean pain intensity score reduced from 5.6 (SD=2.1) at baseline to 2.6 (SD=2. 

It is widely known, that introducing palliative care (PalC) at an early stage, will greatly benefit patients and their families, by controlling symptoms and the psychosocial burden. The NECPAL CCOMS-ICO tool aims to identify patients in need of palliative care at an early stage, and accurately predict mortality in order to facilitate end of life care planning and hence improve quality of life.

We conducted an observational prospective study, of patients admitted to the respiratory ward in our institution during a period of 3 months. We assessed, using this tool, which patients met the criteria to be referred for PalC and whether or not they were indeed referred. We also compared mortality rates in the 2 groups with a 3month follow-up. 

Study population was primarily > 60 years (mean 61.6 + 11.3), male (69%), White (75%), oropharyngeal/oral cavity (55%), stage IV (54%), and undergoing cancer treatment (66%). Among all participants, 15% had a total of 25 visits with palliative care specialists within three months to one year after enrolling in the ePVA study. The reasons for palliative care visits were primarily directed toward pain, followed by medical marijuana and non-pain symptoms including nausea and anorexia (see Figure 1 ).

Medical marijuana may have a role in management of high symptom burden from head and neck cancer and its treatment. The Electronic Patient Visit Assessment (ePVA) for head and neck cancer was developed to trigger palliative interventions for complex symptoms and function limitations. We explored whether symptoms or function limitations identified by ePVA were associated with number of palliative care visits.

Retrospective analysis using existing data collected with the ePVA combined with data abstracted from electronic health record (EHR). Symptom and function limitations were coded as present or absent. Palliative care visits 3 -12 months after initial ePVA completion were abstracted from EHR. Analyses included general linear models using generalized estimated equations (GEE) with Poisson distribution, controlling for length of time after initial completion of ePVA.

Participants were mean age 62, primarily male (69%), White (75%), and undergoing cancer treatment (66%). Each additional symptom identified by ePVA was significantly associated with increase in number of palliative care visits by 15% (see Table 1 ).

Number and type of symptoms may be predictive of need for palliative care services for patients with head and neck cancer. 

Chimeric antigen receptor (CAR) T-cell therapy is a promising development for adults with refractory diffuse large B-cell lymphoma and primary mediastinal B-cell lymphoma. Treatment is often last line but with curative intent. CAR T-cells are associated with unique toxicities, sometimes requiring aggressive supportive care. Little is known about the palliative care needs of this group.

Retrospective quantitative and qualitative case note analysis of all patients admitted for CAR T-cell infusion between January 2019-September 2020 at the Northern Centre for Cancer Care, Newcastle-Upon-Tyne.

Results 34 patients received CAR T-cell therapy. Overall survival rates were 94% at 28 days, 88% at 3 months, and 54% at 6 months. Overall, symptom burden was significant ( Figure 1 ). All patients experienced at least one symptom. 82% of patients experienced two or more symptoms. None of the patients were previously known to the palliative care team (PCT). Nine patients (26%) were referred to the PCT during admission. Advance care planning discussions were more frequent in patients reviewed by the PCT. Issues included the challenges of coordinating end of life care across a wide geographical area and the possibility of acute, rapid deterioration at the end of life.

CAR T-cell therapy is an exciting development for treatment of refractory B-cell lymphoma, but patients continue to face prognostic uncertainty with evidence of unmet palliative care needs and significant symptom burden. More work is needed on the impact of integrated supportive care in this group.

S. You 1 1 Wonju Severance Christian Hospital, Radiation Oncology, Wonju, South Korea

Current capacitive hyperthermia can cause postural constraints due to bulky electrode system. We describe whether ultra-thin adhesive electrode-connected hyperthermia system is feasible in palliative care. Methods 2-MHz frequency stimulator-mediated local hyperthermia was applied in a twice-a-week schedule during conventional palliative radiotherapy (33.8-45.0 Gy). Each session lasted 60 min with 22x17-cm2 rectangular electrodes attached to the body in pairs. Positioning was selected considering pathological symptoms such as pain, cough, or dyspnea. Applied power (30-70 W) was determined below acceptable levels of patients' discomfort, reflecting the impedance (40-51 Ω). Tumor size and NK cell activity were compared before and after the treatment.

Of the 15 patients enrolled, 12 had symptoms (pain (7), dyspnea (3), dysphagia (1) , and leg edema (1)) and the other 3 was nonsymptomatic (prophylactic purpose). Nine patients (75%) 

The aim of this study was to evaluate using the compound probiotics supplements (BP-1) during chemotherapy to improve the quality of life (QOL) of the patients with lung cancer.

Patients with lung cancer and chemotherapy-naive were screened, and randomly divided into two groups: the research group received BP-1 twice a day along with chemotherapy, while the controlled group received the placebo. The QOL of patients before chemotherapy, 1-month and 2month after the chemotherapy were evaluated according to EORTC QLQ C30. The diversity and composition of the gut microbiota were evaluated by 16S rRNA sequencing. The endpoints included: (1) EORTC QLQ C30 score variation; (2) incidence of chemotherapy-induced side effects. The explorative endpoint was the composition and diversity of the gut microbiota.

From March 2019 to January 2020, 110 patients were recruited. The score of QLQ-30 of the research group remains approximately the same as the score of the baseline after chemotherapy, while the score of the control group changed to a worse level. There was a significant difference between the two groups in the dimensions of vomiting, appetite loss, constipation, diarrhea. The relative abundance of families such as bifidobacteriaceae and lachnospiraceae increased significantly in the BP-1 group, while bacteroidaceae decreased significantly.

Conclusions BP-1 can improve the QOL and reduce some side reactions of patients with lung cancer during chemotherapy, the above effects maybe related to the optimized gut microbiota by BP-1. -Online survey -Self-rated competence (Bondy Scale), frequency of use and access to assessment tools in pediatric oncology.

-Semi-structured phone interview: Exploring service structure, staffing, assessment tool use, key time points, peripheral neuropathies.

Physiotherapy workforce in pediatric oncology is significantly underresourced across Australia. The average number of newly diagnosed patients to 1-EFT physiotherapy is 255 (range 90 to 325). Mainstay of assessment of physical function is not using validated tools but functional and impairment-based with wide variability between participants. Barriers to using standardised assessments were time, staffing, space, knowledge, medical stability of patients, lack of validated, reliable outcome tools.

There is a need to strategically advocate for physiotherapy resources in pediatric oncology and overcome barriers to using validated assessment tools in order to evaluate the impact of physiotherapy. Children undergoing Acute Lymphoblastic Leukemia (ALL) treatment are at risk for developing drug-induced hyperglycemia (DIH), which occurs in approximately 10-20% of patients. Hyperglycemia is associated with increased infections and worse overall survival.

Members of the oncology and endocrine teams collaborated to develop a protocol to proactively screen for and manage DIH (2 or more glucose levels ≥200 mg/dl). This protocol incorporated inpatient and outpatient glucose checks during high-risk periods of chemotherapy. (Fig 1-2 

This case is of a six-month-old female who presented with recurrent anaemia and multiple transfusions. A complete blood count, cytochemical, Immunophenotyping and molecular analysis done classified patient as having a Ph Negative, infant ALL (mature B type). The patient had some supportive care which was inadequate due to the lack of aphaeresis machine in our centre. The patient was referred to a bigger centre for more supportive care and commencement of chemotherapy.

Infant ALL unlike other childhood ALL is very difficult to manage. It requires a higher level of competence which is lacking in this part of the world. Lack of expertise in the management of infant leukaemia and supportive care is a major problem in the third world. More physicians training and collaborative researches between foreign and local medical institutions can help improve care.

Female patients with childhood, adolescent, and young adult (CAYA) cancer are at increased risk for fertility impairment when treatment adversely affects reproductive organ function. Substantial variations in clinical practice guidelines (CPGs) limit consistent and timely implementation of effective fertility preserving interventions. As part of PanCareLIFE, and in collaboration with the International Late Effects of Childhood Cancer Guideline Harmonization Group, a fertility preservation CPG was developed to assist healthcare providers to communicate the potential risk for infertility and provide guidance about which fertility preservation methods to offer. 

Chemotherapy can affect smell and taste function, however, this has never been investigated in childhood cancer patients. The objective of this study was to determine whether psychophysical smell and taste tests are suitable for children with cancer. Taste and smell function, fungiform papillae density, and eating behavior were measured before and after a cycle of chemotherapy, and compared with healthy controls. Methods Thirty-one childhood cancer patients and 24 healthy controls participated. Smell function was measured using Sniffin' Sticks, including a threshold, discrimination, and identification test. Taste Strips were used to determine recognition thresholds for sweet, sour, salty, and bitter taste. Papillae density was investigated by counting the fungiform papillae of the anterior tongue. Eating behavior was assessed using the Behavioral Pediatrics Feeding Assessment Scale.

Smell and taste function could be investigated in more than 90% of the patients, while fungiform papillae density could be determined for 61% of the patients. In comparison with healthy controls, patients had lower smell and sour taste thresholds (p < 0.05). Patients showed improvement of sweet (p < 0.001), bitter (p = 0.028), and total taste (p = 0.004) after a cycle of chemotherapy.

This study demonstrates that the assessment of smell and taste function and fungiform papillae density is feasible in childhood cancer patients. In addition, results of the current study suggest that smell and taste function improve in children with cancer.

Long-term prostate cancer (PC) survivors might suffer from pain, fatigue and depression. These symptoms are collectively known as the psychoneurological symptom (PNS) cluster. We aimed to identify possible classes of the PNS cluster, to classify PC survivors accordingly, and to explore associations between classes of the PNS cluster and health-related quality of life (HRQoL). Methods 653 stage T1-T3N0M0 survivors were identified from the PROCAS study. Fatigue was assessed with the EORTC QLQ-FA12, depressive symptoms with the MHI-5, and pain with the EORTC QLQ-C30 questionnaire. Latent class analysis was used to derive cluster classes. Factors associated with the derived classes were determined using multinomial logistic regression analysis.

Three classes were identified: class 1 (61.4%) -'low pain, low physical and emotional fatigue, moderate depressive symptoms'; class 2 (15.1%) -'low physical fatigue and pain, moderate emotional fatigue, high depressive symptoms'; class 3 (23.5%) -high scores for all symptoms. Survivors in classes 2 and 3 were more likely to be physically inactive, report a history of depression or some other specific comorbidity, be treated with radiation therapy, and have worse HRQoL outcomes compared to class 1.

Three distinct classes of the PNS cluster were identified, which are associated with treatment, comorbidities, lifestyle factors, and HRQoL outcomes. Improving classification of PC survivors according to severity of multiple symptoms could assist in developing interventions tailored to survivors' needs. implementation strategies to organizational readiness and barriers/enablers. In this formative phase of our implementation-effectiveness trial of SMS in routine care, we evaluated readiness based on constructs in the Consolidated Framework for Implementation Research (CFIR) and mapped implementation strategies to inform tailoring to local context.

We used surveys and qualitative interviews to assess readiness and barriers/enablers for SMS amongst stakeholders in 3 disease site groups at 3 regional cancer centres (RCCs). Median survey responses were classified as a barrier, enabler or neutral based on a priori cut-off values and mapped to CFIR and inputted into the CFIR -Expert Recommendations for Implementing Change Strategy Matching Tool v1.0 (CFIR-ERIC) to identify centre-specific implementation strategies. Results SMS in the RCCs was not systematically delivered, yet most stakeholders (n=78; respondent rate =50%) valued SMS. For Centre 1, 7 barriers/12 enablers were identified, 14 barriers/9 enablers for Centre 2, and 11 barriers/5 enablers for Centre 3. Of the total 46 implementation strategies identified, 30 (65%) were common across centres with additional tailoring required for all 3 sites.

The CFIR and CFIR-ERIC and NPT were valuable tools for tailoring implementation strategies to barriers and enablers and identifying the clinical work of SMS implementation.

This study aimed to evaluate association between cancer education program and emergency room (ER) visits treatment and mortality in real world setting. Methods This is a retrospective cohort study with 146,489 cancer patients at cancer education center from 2011 to 2017. Records of education program participation, and clinical information were obtained from EMR. Multivariable logistic regression was conducted to find factors associated with program participants. Cox regression was used to evaluate association between cancer education and clinical outcomes after propensity score matching.

Of total 4.2% (N = 6,182) patients participated in education programs. Patients who were from rural area (Odds ratio (OR) =1.11, 95% CI =1.03, 1.20), and diagnosed with regional cancer (OR =1.55, 95% CI = 1.45, 1.65) were more likely to participate in the program than patients from metropolitan area, and diagnosed with localized cancer. After adjusting age at diagnosis, sex, type of cancer, and SEER stage, patients who took education program were less likely to visit ER (hazard ratio (HR) = 0. 64, 95% CI = 0.61, 0.67) or die (HR = 0.89, 95% CI = 0.81, 0.98).

Less than 5 % cancer patients participated in education program and patients who were from rural area or advanced stages were more likely to participate in the program. Cancer education program could be beneficial not only for psychological supports but also for clinical outcomes including mortality.

Distress from altered physical appearance is one of the often sources of emotional disproportional needs during and after the treatment. A prospective way to encourage women to return self-confidence and belief in the possibility to grapple with the cancer is an art-therapeutic photo session and storytelling about her illness path. Such photo session may be a point of entry for women to the supportive way of ex-patients journey: there is a list of charity organizations which provide social and psychological support to the patients.

We use the metaphor ex-relationship with a boyfriendit was in my life, it is in the past and I am full of life and sure the best future for myself. The woman has professional photos where she is beautiful and happy and her story is published on the site of the project. There is a piece of information about the different types of help to the patients offered by foundations on the site.

The project has the first results: 13 charity fund partners are presented, the national information campaign is started, it is presented to the Moscow government for partnership. The presentations on the national TV programs and glance magazines motivated women with cancer to talk about the disease, ask the help and receive it.

We are looking forward to the project development. We believe our program would be an inspiring place of info-source for female cancer survivors. We are planning to use metrics that help to assess the socioeconomical effect of uplifting ex-patients photo sessions. 

There is a need for information on the COVID-19 vaccines for people affected by cancer. Cancer Australia will continue to communicate evidence-based guidance to inform and support the Australian cancer community.

As cancer incidence rates continue to increase, patient empowerment has become a relevant topic for health promoting interventions that emphasize the active and informed role of patients. So far, most studies have mainly focused on medical aspects and little evidence has concentrated on the psychosocial outcomes of empowerment-based interventions. The aim of this study is to explore the effects of Mindfulness-Based Stress Reduction (MBSR), a clinical program commonly integrated in supportive cancer care, on patient empowerment.

This French mono-centric pilot study used a waitlist-control design. A total of 27 cancer patients (mean age = 50 years; 96% women) completed sociodemographic, empowerment (HEIQ), and mindfulness (FFMQ) measures at baseline and Time 1 (post-treatment/post-waitlist).

At follow-up, the HEIQ dimensions, "social integration and support", "constructive attitudes and approaches" and "skill and technique acquisition", significantly improved among MBSR participants (n = 21) when compared with waitlist-control participants (n = 8). In addition, a significant increase in mindfulness scores has been registered for MBSR participants.

Conclusions This is the first study explicitly examining the effects of MBSR on patient empowerment. MBSR appears to be a promising empowerment-based approach for cancer patients, particularly for health related psychosocial issues. Further controlled trials with larger numbers of participants are required.

Chemotherapy-induced peripheral neuropathy (CIPN) becomes chronic in 30% of cancer patients. Knowledge of the predictors of chronic CIPN and related impairments in health-related quality of life (HRQoL) is lacking. We examined the role of dispositional optimism in chronic CIPN severity and associated HRQoL in colorectal cancer (CRC) patients up to two years after diagnosis. Methods CRC patients from a prospective cohort study who reported sensory peripheral neuropathy (SPN) one year after diagnosis (N=140) completed questions on dispositional optimism (LOT-R) and SPN severity/HRQoL (EORTC QLQ-CIPN20 and QLQ-C30).

Multivariable regression analyses showed that optimism was not related to SPN severity. At 1-year follow-up, higher optimism was associated with better global QoL and better physical, role, emotional, cognitive, and social functioning. Optimism at year one was also prospectively associated with better global QoL, and emotional and cognitive functioning at 2-year follow-up. After controlling for depressive and anxiety symptoms, all significant associations became non-significant.

Dispositional optimism as well as depressive and anxiety symptoms are associated with HRQoL in CRC patients with chronic CIPN. Future research may shed light on the mechanisms that these factors share, like the use of coping styles such as avoidance and acceptance, that may inform the design of targeted interventions to help patients adapt to chronic CIPN.

The American Society of Clinical Oncology Clinical Practice guidelines recommend that non-physicians should be prepared to discuss fertility and sexual concerns with patients. However, literature showed that women with cancer still found such counseling inadequate. We conducted a scoping review to understand non-physicians' barriers and facilitators providing sexual and reproductive health (SRH) care to women of reproductive age with cancer.

We searched six databases using the criteria: 1) English-language; 2) original research; 3) non-physician providers; 4) women with cancer under age 50. We categorized barriers and facilitators at the macro-, encounter-and individual-levels from provider's and patient's perspectives.

We included 27 studies from 3,245 retrieved articles. At the macro level, the main barriers for non-physicians were lack of SRH care guidelines and collaborating experts. Concerns for patients included socioeconomic and geographic constraints. At the encounter level, providers and patients lacked experience discussing SRH. At individual level, providers' lack of knowledge in SRH treatment options and interprofessional collaboration and patients' lack of awareness about treatment effects hindered SRH discussions. Facilitators include the availability of SRH programs and specialists, and rapport between providers and patients.

Supporting non-physician to provide SRH services to women with cancer requires investment in clinical guidelines, interprofessional collaboration and training in patient communication. 

The objective of the study was to identify risk factors for maladaptive coping in advanced cancer patients.

We conducted a secondary analysis of a cross-sectional survey on chemical coping. We prospectively enrolled advanced cancer patients and documented patient demographics, symptoms (Edmonton Symptom Assessment System), Zubrod performance status, substance use, and coping strategies (the Brief COPE Questionnaire). Multivariate analyses were performed to identify risk factors for maladaptive coping.

Among 399 patients, the most common malignancies were gastrointestinal (21%) and breast (19% 

Patients with primary brain tumors have high symptom burden and rely on family caregivers (CG) for practical and emotional support often resulting in negative CG emotional and physical outcomes. We investigated effectiveness of an 8-week nurse-led needs-based intervention (SmartCare©) with and without online self-guided cognitive behavioral therapy (CBT) for depression compared to enhanced care as usual (ECAU) on depressive symptoms, caregiving distress, anxiety, mastery, and burden.

Family CG (n=120) with depressive symptoms were randomized to three groups: SmartCare© plus/minus self-guided CBT, or ECAU. Primary outcomes were depressive symptoms (CES-D); caregiving distress (CG Needs Screen); secondary outcomes were CG anxiety (POMS-A), mastery (CG Mastery Scale), and burden (CG Reaction Assessment). Post intervention outcomes were analysed with Intention to treat (ITT) analyses of covariance corrected for baseline scores.

Accrual and CBT engagement were lower than expected, thus intervention groups were combined (n=80) and compared to ECAU (n=40).

There was no group effect on depression, but caregiving distress decreased in the intervention group compared with ECAU (ITT: p=0.01, partial ɳ2=0.08). There was a trend towards improvement in mastery for the intervention group compared with ECAU (ITT: p=0.08, partial ɳ2=0.04). Conclusions SmartCare, with or without self-guided CBT, reduced caregiving distress with a trend towards improving mastery. SmartCare has the potential to improve the lives of families coping with a brain tumor diagnosis. 

Oncologists were more likely than MHPs to report the following barriers: patients don't want to complete PROs; not being trained; not enough funding; insufficient technology; & not knowing how to interpret PRO results. MHPs were more likely than oncologists to report PROs did not account for patient differences and does not add anything to clinical judgment. Oncologists were more likely than MHPs to report that PROs improved communication and helped patients get better faster. MHPs were more likely to report PROs helped justify continued treatment. Current PRO users were more likely than never users to report PROs do not account for patient differences and that they did not have enough time. Never users were more likely than current users to say leadership was not supportive of PRO use.

When PROs are implemented in oncology care, they should be explained to patients so they understand why they are completing them & sufficient support should be provided to oncologists. N e t h e r l a n d s C o m p r e h e n s i v e C a n c e r O r g a n i s a t i o n , Research&Development, Utrecht, The Netherlands

Objective Patients with cancer can experience emotional consequences of reduced ability to eat, of which the impact is unknown. This study assesses the impact of emotional consequences of reduced ability to eat, and patients' satisfaction with healthcare professionals (HCPs) support. Methods A cross-sectional survey was conducted in patients diagnosed with head and neck, lung cancer and lymphoma who experienced reduced ability to eat in the past year. The questionnaire included impact of emotional consequences and patients' satisfaction with HCPs support for reduced ability to eat (scale 0-10). Differences in patient characteristics between unsatisfied (score<6) versus satisfied patients (score≥6) with HCPs support were tested with independent t-tests and Chi-square-tests.

Overall, 116 patients (48%) responded and 101 were included in the analyses. The most impactful emotional consequences were: disappointment (mean ± standard deviation: 8.31±1.49), sadness/grief (7.90±1.91), and anger (7.87±1.41). A lower patient satisfaction with HCPs support was seen in patients longer after diagnosis (p<.01), and in patients who expected no improvements regarding their reduced ability to eat (p<.01).

The impact of emotional consequences of reduced ability to eat is high. HCPs detection and support for these emotional consequences is needed, especially in patients longer after diagnosis, and in patients who expected no improvement.

N. Lize 1 , N. Raijmakers 2 , R. van Lieshout 3 , M.Youssef-El Soud 3 , A. van Limpt 3 , M. van der Linden 4 , S. Beijer 5 1 N e t h e r l a n d s C o m p r e h e n s i v e C a n c e r o r g a n i s a t i o n , Research&development, Utrecht, the Netherlands 2 Netherlands Association for Palliative Care, Netherlands Comprehensive Cancer organisation, Research&development, Utrecht, Utrecht 3 Maxima Medical Centre, Longgeneeskunde, Veldhoven, the Netherlands 4 Amsterdam Universitair Medical Centre, Psychologie, Amsterdam, the Netherlands 5 N e t h e r l a n d s C o m p r e h e n s i v e C a n c e r o r g a n i s a t i o n , Research&development, Eindhoven, the Netherlands

Patients with cancer often experience a reduced ability to eat. This can have psychosocial consequences for both patients and informal caregivers. Current literature is mainly focused on patients with end stage advanced disease and cancer cachexia. This qualitative study provides new insights in the field of Psycho-Oncology by exploring psychosocial consequences of a reduced ability to eat in patients in different stages of the disease and in recovery and remission.

Semi-structured interviews (n = 26) were conducted in patients with head and neck, lung cancer or lymphoma. Patients' informal caregivers participated in 12 interviews. All interviews were recorded, transcribed and thematically analysed using Atlas.ti.

Four themes emerged related to psychosocial consequences of a reduced ability to eat: struggle with eating, high sense of responsibility, misunderstanding by social environment and social consequences. Emotions mentioned by patients and informal caregivers were: anger, anxiety, disappointment, grief and sadness, guilt, powerlessness and shame. The theme social consequences was related to: less pleasure experienced and the social strategies: adjust, search for alternatives and avoid.

Patients with cancer and their informal caregivers experience a wide range of psychosocial consequences of reduced ability to eat during all phases of the disease trajectory and in recovery and remission. It is important to recognise and acknowledge this struggle to optimise future care.

Individual resilience is a key factor in the response to adversity experienced by adults with cancer. Based on a concept analysis of individual resilience, we developed a preliminary conceptual model of individual resilience in adult cancer care. This study aimed to examine and refine this model through exploring the perspectives and experience of resilience of adults with colorectal cancer in the context of their illness.

Qualitative inquiry was the study design. Twelve participants diagnosed with colorectal cancer that had completed treatment were recruited. The meaning of resilience was explored using in-depth individual interviews. Following thematic analysis, qualitative findings were mapped against the preliminary model to refine this model.

Five aspects of individual resilience in adults with colorectal cancer were included in the refined conceptual model: (1) seeking motivations to move forward (seek motivations to overcome cancer); (2) striving for normality (make efforts to live normally) (3) adapting and managing self (adjust self); (4) drawing on external supports (engage with social and healthcare supports); and (5) redefining self (reconsider one's perception of self).

The refined model conceptualises individual resilience in adults with colorectal cancer, which may be beneficial for healthcare providers to identify those who may be at risk to develop adaptation difficulties. This model may be used to further develop and test cancer specific resilience measures and develop interventions to facilitate resilience.

Cancer-related cognitive difficulties (CD) may negatively impact quality of life, but sex differences are understudied. The aim of this study was to describe the presence, severity, and predictors of CD in females and males with hematological cancers (HC).

Adults with HC completed patient-reported outcome measures, including a single item of CD, as part of standard care from 2010-2019. Patients reported CD as "no difficulty", "a little", "quite a bit", or "very much". Descriptive statistics and multivariable logistic regression were used to assess CD presence and severity and examine potential predictors of high CD (defined as "quite a bit" or "very much").

Of 1018 patients (57% male, mean age 54 years, mean 6.5 years postdiagnosis), 63% reported presence of CD and 27% reported high CD. Females had higher rate of any CD (70% vs. 58%) and high CD (36% vs. 20%) than males. In both females and males, high CD was associated with higher fatigue and depression. Younger males were more likely to report high CD than older men, but this age effect was not observed in 

Pain affects up to 90% of individuals with advanced cancer diagnoses. Approximately 38% of those with cancer associated pain report a moderate to severe pain experience. Understanding pain pathophysiology and its components may help to manage difficult situations.

We present the case of a patient with severe pain, where total pain was identified by the Palliative Medicine team requiring an interdisciplinary approach, in order to control her pain.

A 35-year-female underwent pelvic exoneration for an advanced gynecologic malignancy. Post-operative course was complicated by GI bleed, perforation and cardiomyopathy resulting in a hospital stay greater than 120 days. Patient developed intractable pain, unresponsive to opioid titration. Intensive interdisciplinary involvement resulted in treatment of non-pain sources of distress, allowed for tapering of analgesia and reduced incidences of pain crises.

This case highlights the importance of assessing physical and nonphysical sources of suffering in individuals who respond poorly to opioids. Those with advanced malignancy are at significant risk of pain, oftentimes related to or exacerbated by psychosocial, spiritual and social distress. The contribution of all members of the interdisciplinary care team was instrumental in assessment and treatment of all sources of distress in this complex patient.

Childbearing is not commonly associated with cancer. Yet, cancer during pregnancy (CDP) is rising alongside a trend for delayed conception affecting 25-27 per 100,000 pregnancies. Research has explored psychosocial issues and decision-making by parents and healthcare professionals (HCP). This has not been subject to systematic synthesis.

This scoping review explored extent, range and nature of research exploring psychosocial issues affecting women, their partners and families with CDP. We searched sources including: CINAHL, PsychINFO, Medline; years 1995-2020.

We identified 1361 papers, 8 met inclusion criteria originating from 7 countries, involving 178 women aged 22-47, (120 with breast cancer) and most (133/144) pregnancies ending in live birth. All investigated health-related outcomes for women and babies: future fertility; recurrence; women's health/survival; future infant outcomes. All described adverse psychosocial outcomes for women, 3 explored positive outcomes (e.g. post-traumatic growth), 1 included partners. Concept of prioritising life (self/foetus) was evident. Care-planning was influenced by continuity of care and emotional/ informational support from HCP, partners, families. Few studies addressed cultural context; peer support; coping strategies. None investigated online/ digital support; social media; other interventions; cost implications. Conclusions CDP is an orphan research area. Robust research across diverse populations is lacking, and HCPs have few resources to draw on when addressing associated complex needs.

Head and neck cancer (HNC) incidence is increasing and so is the number of long-term survivors. The HNC patient concerns inventory (PCI) is a condition-specific prompt list that allows patients to raise concerns that otherwise might be overlooked. Alongside a 3-year clustered-randomised controlled trial (Trial registration: 32,382, NCT03086629) we undertook a qualitative evaluation of using the PCI in routine post-treatment consultations, with a sample of consultants providing care.

Face-to-face, semi-structured interviews were utilised, aided by a topic guide. Interviews took place in the healthcare setting, audio-recorded, lasting between 20-30 minutes. Audio-recordings were transcribed verbatim, and analysed using Clarke & Braun's thematic framework.

Three overarching themes were identified with seven out of eight recruited consultants involved in the trial arm of the PCI, namely: 1) Enhancing the consultation-an integral holistic dimension, 2) Utilisation of the PCI in routine care, and 3) Barriers and facilitators to implementation of PCI.

Consultants involved in this study were in favour of using the PCI within their clinical consultations in the future. Use of the PCI did not elongate consultation time, but enabled clinicians to be more cognisant of the overall breadth of patients' needs, especially surrounding emotional and sexual wellbeing. The PCI can function as a trigger for patient issues, potentially allowing for more effective communication and subsequent earlier offer of advice, guidance or onward referrals.

Up to 54% of people with cancer do not adhere to their oral antineoplastic drug (OAD) prescriptions. The need to make adherence self-management tools available to people treated with these drugs has been highlighted. However, these interventions should be informed by evidence of the reasons that some people find it difficult to take their oral antineoplastic drugs as prescribed.

Medline, Embase, Emcare and PsychINFO databases were searched for systematic reviews and research-based studies published between 01/ 2010 and 03/2018 that investigated the reasons for OAD non-adherence. Data was extracted and analyzed by two independent reviewers.

Three systematic reviews and two research-based studies were included. There was a predominance of studies with chronic myeloid leukemia and breast cancer patients. Lack of rigorous methodology and differences in adherence cut-off rates were observed across the studies. Key modifiable reasons for OAD non-adherence were: side-effects, forgetfulness, and poor OAD knowledge. The main non-modifiable factors were: co-payment, regimen complexity, longer time since diagnosis/taking OAD, younger and older age, and female gender only in chronic myeloid leukemia (mixed findings).

Medication adherence is a complex, multifactorial phenomenon but a number of key factors for OAD nonadherence are highlighted. Knowledge about the factors influencing OAD is important for accurate assessment and development of interventions to support medication adherence in people taking OAD.

People affected by chronic diseases including cancer report high distress levels and unmet psychosocial needs. It is unclear whether telephonebased services are a practical setting for distress screening and management. This systematic review describes the distress screening and supportive care referral practices used in telephone-based services. Methods A systematic literature search was conducted for articles published from 1990 to 2018. Studies included patients or caregivers affected by one of 11 chronic diseases and a health service that assessed distress via telephone. Extracted data included: chronic disease type, sample size, screening tool, referral or rescreening protocols, and type of health service.

The search identified 4019 articles; 14 were eligible for full-text review.

Of the 14 studies, 13 included cancer patients and nine validated distress screening tools were reported; the most common was the Distress Thermometer. Studies were conducted in Australia, France, Switzerland, UK and USA. Referral pathways were reported in 7 studies. Rescreening was reported in 7 studies of which, 4 hospital based studies reported ongoing screening. Only one study included rural patients.

Validated distress screening tools are being used by telephone services to identify distress. However, not all services use an established referral pathway following screening. Rescreening of callers' distress is also limited despite inclusion in multiple psycho-oncology guidelines internationally.

Caregivers of cancer patients experience high levels of distress. With increasing survivorship and outpatient service delivery, informal caregivers are now essential in health care delivery and play a role in improved patient outcomes. However, their own wellbeing is seldom acknowledged. This Australian study explored caregiver's sources of distress at diagnosis, treatment, survivorship or palliative and bereavement stages.

Semi-structured interviews were conducted with a purposive sample of distressed caregivers within the Structured Triage And Referral by Telephone (START) trial. Grounded theory was used to generate themes with data analysed by two independent coders via NVivo software.

Caregivers (n=14) 

Qualitative and quantitative data was gathered from 150 chemotherapy patients in 9 countries, who had used/were currently utilising the Paxman scalp cooling device, through an international questionnaire.

Five key areas of patient wellbeing were positively impacted by scalp cooling, 99% of patients reported scalp cooling had some impact on their emotional wellbeing, with 93% stating a very significant/significant impact on emotional wellbeing in addition to social activities (84%), work activities (77%), relationships with family and friends (70%) and physical/sporting activities (60% 

A psychology student was selected for this project. Questionnaires to identify obstacles for the treatment were applied and a training granted by the Global Cancer Institute (GCI) guided the navigation.

From July 2018 to January 2020, 73 patients in need of RT were included in the project, from all over the state. They were guided by weekly contacts, received help with documentation, appointment schedules and information about their rights.Common points were difficulties in transportation, dialogue and family support. In all patients and caregivers, levels of anxiety and stress were identified. As the treatment proceeded, there was a decrease in these levels (measured through questionnaires) with high rates of patient satisfaction with the navigator (≥9/10 for all patients).

Beyond clinical care, the psychologist may exert other roles in an oncological team. This emphasizes the importance of psycho-oncology in core education as well as a new field of specialization. In addition to initial training that allows skill development, the presence of an experienced institution as GCI is important to make navigators feel empowered to perform their role. 

One of the most significant psychological problems of patients with and survivors of cancer is a fear of cancer recurrence (FCR) which is a lifelong burden. Trials show that it persists many years after treatment even prognosis is excellent. Breast cancer is a frequently diagnosed and well-treated disease. We are looking for effective evidence-based tools to support survivors and try to key these to Russia.

Canadian psycho-oncologists have proffered Conquer Fear of Cancer Recurrence program of group therapy (Sophie Lebel, University of Ottawa) which was assayed in the Moscow region of Russia. In our testing, this evidence-based program consists of five instead of six group settings at a shorter program's time duration. Psychometrics (FCRI included) was before the program start and two times after finish (one and three months later). Survivors of breast cancer were residents of Supportive Center "Together" by Charity Fund Supporting Women with Cancer "Further".

After five group settings twice a week, anxiety and fear reduced and the effect was lasting three months ago despite some corrections to the original program. The positive effect was rising in months after therapy finish.

Conquer FCR group program based on contemporary CBT and has effectiveness for as well Canadian as Russian survivors. We should use special psychometrics for FCR assessment (FCRI) which is necessary to implement in practice. As a general matter, we recommend Conquer FCR program for survivors. 

Patients with cancer and their partners can face significant sexual challenges. Guidelines recommend that healthcare professionals (HPs) provide sexual support, but this is not routine practice. Lack of HPs knowledge and confidence are key barriers. A theory-driven, positively evaluated prostate cancer eLearning resource for HPs was adapted and tested to enhance sexual support across cancer care.

Using the Person-based approach, the 'Talking about sex after cancer' eLearning resource was created by combining empirical evidence, input from key stakeholders (n=27: patients, partners and HPs working in cancer care) and an expert research team. The prototype was optimised using 'think aloud' interviews (n=18), which identified modifications and provided feedback on HPs' view of the resource.

This process demonstrated the ability to develop an evidence-based, informative, and clinically relevant sexual care eLearning resource for HPs working across cancer care. Usability testing identified and resolved navigational difficulties. HPs reported the resource as an engaging and indispensable tool to address the barriers they faced in providing sexual care, as it contained much needed communication strategies, and signposting tools to support practice.

This eLearning resource addressed the gap in HP knowledge and skills and has the potential to positively impact future sexual healthcare provision across cancer care to maximise sexual wellbeing. Graham 1, 6, 7 Introduction This systematic review aimed to synthesize the evidence on interventions utilized by Indigenous Peoples living with cancer, and report on their relevance to Indigenous communities and alignment with holistic wellness.

We conducted a systematic review with narrative synthesis.

Of the 7995 records obtained, 27 articles evaluating 20 interventions were included. They were conducted in USA (n=21), Australia (n=5) and Peru (n=1), using cross-sectional (n=13), qualitative (n=5), mixed methods (n=4), experimental (n=3) and quasi-experimental (n=2) designs. Relevance to participating Indigenous communities was moderate to low. Interventions had diverse aims, ingredients, and outcomes. Aims involved: 1) supporting the cancer journey, 2) increasing knowledge, 3) providing psychosocial support, and 4) promoting dialogue about cancer. Ingredients included: community meetings, patient navigation, arts, and printed/online materials. Participants were predominately female and outcomes were positive in 89% of studies. No studies addressed all dimensions of holistic wellness (physical, mental, social, spiritual) central to Indigenous health in many communities.

Selected studies represented a small number of Indigenous Peoples and did not meet relevance standards in reporting engagement with Indigenous communities. Cancer survivorship interventions need to be relevant, culturally safe and effective, and honouring diverse Indigenous concepts of health. 

Out of the 2762 studies, 33 were included for qualitative analysis and 27 for meta-analysis that studied the effect of aerobic training(AT), resistance training(RT), combined exercise(CE), yoga, tai-chi and physical activity(PA). 33 studies analysed sleep and 5 analysed circadian rhythm. The intervention duration ranges were, AT-5days-1year, RT-12weeks, CE-3weeks-3months, yoga-4weeks-1year, tai-chi-7weeks-3 months and PA-3months. Meta-analysis indicated significant improvements in CR with yoga and AT. RT significantly reduced sleep disturbance at the post treatment phase. Other interventions showed a trend towards improvement in selfreported sleep outcomes, although not statistically significant. Varied study duration and cancer groups are the possible reasons for the heterogeneous results.

Yoga and AT are beneficial in improving CR. However, there is insufficient evidence currently to support the benefits of variety of exercise modes in improving self-reported sleep outcomes. Introduction Cancer diagnosis and treatment may affect individuals and their relatives emotionally and physically, mostly at the end of initial cancer treatment when some survivors express fear of abandonment as they may no longer have regular contacts with health professionals. Evidence shows poor health care experiences and low uptake of cancer support services among UK BAC population. Hence, the need to examine how they transit from professional care to self-management; and the challenges faced by their family caregivers.

This research was made up of two qualitative studies which received University of Huddersfield's ethics approval. Study 1 involved UK BAC cancer survivors and their family caregivers; and collected data through audio-recorded face-to-face semi-structured interviews involving visual aid (Pictor technique); transcribed and analysed using the Template Analysis approach. Study 2 explored the policy and practice implications of study 1 findings through a focus group discussion with UK cancer care stakeholders.

The emerged findings included the lack of cultural awareness and limited Black representation among care providers; inadequate information and support for both survivors and their family caregivers; and lack of insight into the challenges faced by UK Black cancer caregivers. 

Cancer survivors and people with diabetes report common co-occurring symptoms. It is unknown if the combination of colorectal cancer (CRC) and diabetes exacerbate these symptoms. This study aimed to identify/ compare the types of symptoms in CRC survivors with/without diabetes during initial treatment.

Unstructured data from electronic health records was searched for symptoms (anxiety, peripheral pain, gastrointestinal, fatigue, depression, physical function, sleep and cognition) in CRC survivors with and without diabetes. Covariates were summarized using frequencies with percentages or means with standard deviations. Logistic regression (LR) and Poisson regression (PR) were performed to evaluate the effects of diabetes on the occurrence of the symptoms and the occurrence rate of the symptoms, respectively. Results 23% of the 1337 survivors had comorbid diabetes. In LR, diabetes was associated with anxiety, peripheral neuropathy, gastrointestinal, fatigue and depression. PR findings indicate that diabetes could significantly increase the rate of occurrence for depression.

CRC survivors with diabetes reported 5/8 common co-occurring symptoms without. Baseline assessments of these symptoms at the initiation of treatment are important to identify the risk for higher symptom profile. Additional research is needed to explore symptoms of CRC survivors, and inform tailored interventions to mitigate the synergistic effects of having both CRC and diabetes 

Latino cancer patients/survivors (CPS) are known to experience significantly higher levels of distress and lower quality of life compared to Non-Latino Whites. Social support resources are limited in availability and uptake among non-English speaking CPS due to language, economic, and socio-cultural barriers. Cancer Awareness, Resources, and Education (CARE) is a cancer wellness support group that offers 3 independent quarterly educational series in English, Cantonese, and Spanish for CPS at a safety-net urban hospital. We aimed to evaluate the role of Spanish CARE for Latino CPS participants.

Qualitative data was collected via focus group and anonymous surveys. Surveys were administered by volunteer staff to participants during the last 3 program sessions. These assessed demographics, cancer diagnosis, perceived social support, and role of the program.

Among 20 Latino CPS and 5 caregivers surveyed, 80% identified education centered around cancer care as the main reason they attended Spanish CARE. Followed by 40% identifying emotional support as the main driver for participation. Other common responses included sharing of experiences among patients affected by cancer (22%). All participants were likely or very likely to refer the CARE program to other CPS.

Spanish CARE provides cultural and language concordant emotional and social support to Latino CPS while providing patient education and wellbeing resources. Our ongoing efforts include the evaluation and comparison of our English and Cantonese-speaking groups. 

The positive effects of exercise interventions on hematopoietic stem cell transplantation (HSCT) related side effects were reported in the previous studies. We aimed to investigate effect of exercise program on HSCT related morbidities during the first 100 days.

Totally 50 patients included in this study and participants were assigned to two groups as intervention group (IG, n=25) and control group (CG, n=25) with simple randomization. For IG, aerobic, muscle strengthening, endurance and stretching exercises were performed through hospitalization and these exercises and walking program were advised as home exercise program after discharge. For CG, exercise recommendations were made. The presence of morbidity was recorded from hospital records up to 100day after HSCT.

The recorded post-HSCT complications were showed in Table 1 . When compared the complication rates of the groups (IG: 20%, CG: 52%), there was statistically significant difference between the groups (Chi-Square test, p=0.018).

Exercise interventions may increase treatment success by improving hematologic reconstitution, immune cell functions, and patients' recovery. The possible confounding factors for effects of exercise on HSCT related morbidity should be investigated in the future studies

Sexual abuse and intimate partner violence is a worldwide health problem that affects up to one-third of all women. Although experience of sexual abuse and cancer may constitute risk factors for sexual dysfunction and low wellbeing, the effects of sexual abuse have received little attention in oncology care. We aimed to explore sexual health and wellbeing in women following pelvic radiotherapy and to determine the relation between sexual abuse and sexual dysfunction, and decreased wellbeing.

Data were collected by using study-specific questionnaires from 2011-2017 in a population-based cohort of female cancer survivors treated with pelvic radiotherapy. Subgroup analyses were conducted, comparing socio-demographics, diagnosis, aspects of sexual health, and wellbeing.

In the total sample of 570 women, 11% had experienced sexual abuse. More women with than without experience of sexual abuse reported feeling depressed (19.4% vs 9%, p=0.007) or anxious, (22.6% vs 11.8%, p=0.007) and had genital pain during sexual activity (52% vs 25.1%, p=0.011, RR 2.07, ). In the total study cohort, genital pain during sexual activity was associated with vaginal shortness (<0.001).

Our findings point out that sexual abuse has a crucial effect on the sexual health outcomes and other aspects of wellbeing among female pelvic cancer survivors. We suggest routine screening for sexual abuse in oncology settings, challenging healthcare professionals to take action to prevent retraumatization and provide appropriate interventions and support.

Research shows exercise is a safe and effective intervention to counteract adverse effects of cancer and its treatment. The Telehealth for Supportive Survivorship Care pilot project trialled the delivery of an exercise and education program via telehealth for cancer survivors.

The 8-week,16-hour pilot program included weekly group exercise sessions delivered by exercise physiologists, followed by education from health professionals using telehealth linking multiple sites, enabling participants to access the program close to home. Evaluation included surveys, focus groups and phone interviews. An action research approach enabled refinement of program delivery.

In total, 110 participants attended 8 programs across 5 rural health services. Self-reported pre-post data from 43 participants showed that 86% increased their weekly physical activity and 48% increased daily fruit and vegetable consumption. Qualitative analysis showed that program access close to home significantly reduced travel time, assisted cancer survivors to re-engage with their health service and increased local social connections.

Results show this is a sustainable method of program delivery with expansion state-wide as the Cancer Wellness and Exercise Program. As such, this model is now embedded in 30 Victorian regional and metropolitan health services with 42 programs delivered to 400 participants in 2019. The Cancer Wellness and Exercise program assists in overcoming social and geographic barriers for cancer survivors to improve health and wellness. 

Patients who undergo hematopoietic stem cell transplantation (HSCT) often have multiple health issues following discharge. In many centers, outpatient follow up is solely conducted by specialist physicians. We aimed to implement and describe the outcomes of a nurse-allied health multidisciplinary clinic.

The clinic consisted of six disciplines -nursing, pharmacy, dietetics, physiotherapy, occupational therapy and social work. All allogeneic HSCT patients were reviewed at two weeks after discharge and on day 100 post allogeneic HSCT, with additional reviews as needed. Occasions of service, interventions, readmission data and physician satisfaction survey were collected prior to and after implementation. Additionally, patient feedback and quality of life survey (FACT-BMT) were collected during the first six months.

From July to December 2019, 57 patients were reviewed in the clinic (475 reviews). Common interventions included; nurse education (n=22), diet prescription (n=103), counselling by social worker (n=53), exercise programs by physiotherapist (n=111), medication lists provision (n=51) and fatigue management (n=43). The clinic did not reduce readmission rate, however positive feedback from patients and physicians were reported. FACT-BMT results demonstrated unmet needs, particularly fatigue management, sexual education and support, body images and back to work support.

This clinic provides an innovative approach to patient-centered care. It has been well received by patients and physicians.

Introduction ACCHN is a malignant tumor with slow, locally invasive growth, with deceptively benign histological appearance and high probability of local recurrence and distant metastasis. The tumor is composed of basaloid cells with small, angular and hyperchromatic nuclei and scarce cytoplasm arranged in three significant prognostic patterns: cribriform, tubular, and solid. Methods A general review of the literature was performed, relative to clinicopathological characteristics and current management of ACCHN. A search was conducted in the electronic databases of Medline, PubMed, Web of Science, and Scopus, 25 articles in English were selected. These articles included results from clinical trials, systematic reviews; multicenter studies retrospective studies, cases series, cases reports, published during 2010 until 2020.

Numerous studies have attempted to demonstrate accurate histological prognostic features, but often produced conflicting results; however, it was found that some tumors undergo dedifferentiation into a high-grade form.

The combination of surgery and radiotherapy (RT) in the postoperative period has shown the best locoregional control of the disease. Despite the use of these techniques, rates of local recurrence and distant metastasis are still high and may occur decades after the initial diagnosis.

Epidemiological data suggests exercise training can alleviate treatmentrelated toxicities in prostate cancer (PC). However, evidence in patients with advanced PC and bone metastases is extremely limited, thus the safety and feasibility is unknown. This prospective case study aims to determine the effects of moderate exercise and behavioural support.

A 64 year-old male with mCRPC and extensive spinal lesions consented. The participant was actively treated with abiraterone acetate, prednisolone and triptorelin. The intervention consisted of 12-weeks of moderate intensity walking and home-based strengthening activities. Independent of the intervention, the participant completed self-administered swimming. At baseline (T1), 12-(T2) and 24-weeks (T3), the participant completed outcome assessments.

Two transient adverse events were reported (pre-existing conditions). The participant completed 44 of 55 prescribed days of walking, totalling 660 mins (prescribed: 1190mins). The participant also self-reported 2150 mins (43 sessions) of moderate intensity swimming exercise. At T2, body mass, hip and waist circumference decreased, while physical testing parameters improved, compared to T1 (6-min walk: 520 -640m; timed sitto-stand: 15 -18 reps). These improvements persisted at T3, despite COVID-19 restrictions.

This case study demonstrates that aerobic exercise (moderate walking and swimming) is safe and feasible in a man with mCRPC and extensive bone metastases. The intervention improved body composition and physical fitness over time.

Introduction People living with and beyond head and neck cancer (HNC) often have long-term, functional challenges as a result of treatment. A key functional challenge relates to eating and drinking; frequently associated with physical, emotional, and social difficulties. Social eating challenges are reported in the literature, however, there are no reviews synthesising this important post-treatment experience. Therefore, a systematic review was conducted to identify and synthesise the literature on the experiences of social eating and drinking for patients following treatment for HNC.

Six electronic databases were systematically searched using subject headings: 'head and neck cancer', 'eating and drinking challenges' and 'experiences' and free-text word searches in February 2020. PRISMA procedures were followed.

Of 6910 records identified, 24 studies met the inclusion criteria. Synthesis of the research findings results in two major themes: 1) the experience of loss associated with social eating and drinking, and 2) adjusting and support to promote social eating and drinking.

Losses associated with social eating affect a person's psychological and emotional well-being and impact on close relationships. People with HNC were more likely to seek and receive support from family or friends, rather than a healthcare professional. Future interventions should promote family orientated resources, incorporating self-management strategies.

Ibrutinib is an oral antineoplastic approved in hematology. Although pivotal trials place its discontinuation at 4-9%, different studies show higher rates and reflect the clinical worsening of patients after Ibrutinib suppression. The objective is to evaluate the percentage of patients who have discontinued the treatment and the causes and consequences of this discontinuation.

Retrospective observational study of patients treated with Ibrutinib from 2014 to 2019. We collected by electronic clinical history, patients who have discontinued treatment with ibrutinib and the next data were taken: diagnosis, duration of treatment, reason for discontinuation and the time elapsed between the suspension of the drug and the death of the patient. Results 31 patients were treated with Ibrutinib, 38.7% of them (12 patients) suspended the treatment: 8 due to serious adverse events and 4 to disease progression. 8 patients were treated for chronic lymphoid leukemia, 2 for mantle lymphoma and 2 for B-cell lymphoma. The duration of treatment was a median of 199 days of treatment. Those patients who discontinued treatment died between 22 and 226 days after the last administration with a median of 37 days Conclusions The discotinuation of Ibrutinib was greater than that exposed in the pivotal trial and adverse events were the most common reason. The results indicate that the suspension of the drug is associated with poor prognosis. We consider necessary to assess the management of adverse reactions in a way that avoids the suspension of treatment. 

To identify the occurrence of late symptom effects among childhood cancer survivors (CCS), generate subgroups using a latent class analysis and determine whether the subgroups differ in demographic and healthrelated characteristics and health-promoting lifestyle. Methods A cross-sectional survey was conducted on 130 adult CCS in Korea. The Memorial Symptom Assessment Scale was used to perform a latent class analysis based on symptom occurrence to generate subgroups.

Difficulty in concentration, lack of energy, worrying, drowsiness, irritability, pain, difficulty in sleeping, nervousness, sadness and dry mouth appeared in more than 50% of the CCS. The three symptom subgroups identified were "all high" (46.2%), "high physical moderate psych" (26.9%) and "moderate physical low psych" (26.9%). The percentage of non-smokers was the highest in the moderate physical low psych subgroup (85.7%; p = .009), and the percentage of heavy alcohol consumption was the highest in the high physical moderate psych subgroup (31.4%; p = .013). Spiritual growth scores and interpersonal relationship scores were statistically different between subgroups (F = 3.35, p = .038; F = 7.55, p = .001 respectively).

The results could guide the development of intervention programmes to strengthen spiritual growth and interpersonal relationships and facilitate further examination of the causal relationship between smoking and drinking and late symptoms of CCS.

Atrial fibrillation (AF) is the most common cardiac disorder in long-term survivors of breast cancer (BC). Direct oral anticoagulants (DOACs) are increasingly used in this setting and real-world experiences are useful to improve the selection and care of these patients.

Patients were retrieved from an institutionally-approved observational study of cardiovascular events in long-term (>10 years) BC survivors, covering most of that population in our region. Diagnoses of AF in patients who signed the informed consent to enter the study ( 2018-2020) were among the endpoints. Data were retrospectively analyzed from the primary care and hospital-based electronic medical records. There was only one case of thrombotic cerebrovascular accident.

Tolerance to DOACs was good in this cohort of elderly BC patients, with a promising low incidence of strokes in this high-risk group of patients. Immunotherapy (IT) and targeted therapy (TT) have improved survival for many patients (pts) with mNSCLC. Their lived experience is understudied. We conducted a single centre, qualitative study to understand concerns and supportive care needs of this novel survivor population.

Eligible pts had mNSCLC, aged >18, English speaking and >6 months post initiation of IT/TT without progressive disease. Semi-structured interviews on physical, psychological, social and functional impacts of diagnosis, therapy and prognosis were recorded and transcribed. The framework method of analysis was used. 20 pts were interviewed from May-December 2019; median age 62 (range 34-83), 13 (65%) female; median time since diagnosis of mNSCLC 27 months (range 10-108). 12/20 (60%) pts had tumours with a targetable mutation (EGFR/BRAF/ALK); 6 were receiving IT, 11 TT, 2 IT + chemotherapy, 1 IT + TT. Dominant themes: chronic IT and TT toxicities (eg. cutaneous, gastrointestinal, fatigue); psychological concerns (living with uncertainty, fear of cancer progression, scan-related anxiety, stigma around smoking); desire for tailored information (internet resources, support groups); and practical issues (financial planning, work, challenges on clinical trials). Long-term survivors of mNSCLC experience significant physical, psychological and functional concerns and unmet needs. These results inform resources needed by this growing survivor group. Further work should examine these issues in a larger sample. 

To identify whether a multidimensional set of unmet needs commonly reported by Breast Cancer Survivors (BCS) combine into a limited number of clusters or patterns. Methods BCS following primary treatment were recruited from four cancer hospitals in China. The Chinese translation of the Cancer Survivor Profile (CSPro) was used to evaluate multiple problems over time. The Chinese version of the FACT-B was used as a measure of Quality of Life. All scales of the CSPro were subjected to a latent class analysis. Comparisons of demographic and clinical variables were also completed.

Descriptive analyses indicated a sample of 1,109 breast cancer survivors with a mean age of 46.6 years old primarily living in urban and rural areas were investigated. The latent cluster analysis revealed two primary groups of problems (symptom burden, functional limitations, health behaviors, economic burden and health-seeking behaviors, all p's < 0.001). Those classified in Cluster 1, can best be described as having greater levels of functional limitations and more limited skills related to health seeking. Cancer survivors in cluster 2 are characterized as reporting higher levels of symptoms and economic strain (all p's<001).

Multiple unmet needs in these BCSs can be reduced to those primarily with functional limitations and poor health seeking skills and those with high levels of symptom and financial burden. Those with greater functional limitations and fewer health care seeking skills care reported higher levels of QoL.

Cancer diagnosis, ageing and comorbidity increases the complexity of care. We explored health professionals' (HPs) perspectives on the needs of older adults post-initial cancer treatment, and their use of patient reported outcome measures (PROMs) in routine practice.

HPs from Greece, Spain, Sweden and the UK, involved in breast, prostate or skin cancer care, were recruited via clinical networks/social media (https://lifechamps.eu/). A mixed-methods design, which involved data collection via online surveys, or telephone interviews. Framework analysis was applied to the dataset. Results 62 HPs participated from 11 specialties, the most common role was General Practitioner (25%) and Clinical Nurse Specialist (19%). Most HPs had ≥11 years' experience of supporting cancer patients (51%). Key patient needs reported were: more time to explain information; support with practical/daily living and monitoring of health status. Overall agreeance for a multi-disciplinary health service with a "focus on the patient" that is closer to home. Most HPs were not using PROMs; yet, all agreed PROMs could help provide "better individualised treatment".

HPs provided the best supportive care within the infrastructure available but expressed the real need for better follow-up health care services. There are several unmet needs of older adults post-initial cancer treatment, such as monitoring patients' physical/psychological status and medication adherence/effectiveness.

Ageing and comorbidity impact on individual functioning, quality of life, and the complexity of care required by older cancer patients. We aimed to identify the healthcare needs of middle-aged (50-64 years) and older adults (65 years+) following initial treatment for breast, prostate or melanoma skin cancer in Greece, Spain, Sweden and the United Kingdom.

This mixed method study collected data via either online surveys or telephone interviews as part of a larger Horizon 2020 project (LifeChamps-https://lifechamps.eu/). Framework analysis was applied to the dataset. Results 70 patients participated, of which, 46 were middle-aged and 23 were older adults (age unknown, n=1). Patients were treated for breast (n=47), prostate (n=16) or melanoma skin (n=7) cancer. 50% (n=35) of patients reported 1-2 comorbidities, whilst 43% (n=30) reported no comorbidities. Both age groups identified the need for ongoing physical and psychological support. Common physical concerns were 'bone health', fatigue and side effects from endocrine treatment. Need for psychological support was more prevalent in middle-aged patients. Perceptions of 'ideal' care included health monitoring, practical information on day-to-day living and support closer to home.

Follow-up care varied across countries and identified gaps in services for ageing adults. Research into methods of support, such as remote digital healthcare, to address these identified health needs is warranted.

POST-TRAUMATIC GROWTH AFTER HEAD AND NECK CANCER: CONTRASTING EXPERIENCES OF POSITIVE CHANGE.

Post-traumatic growth (PTG) may be associated with better health related quality-of-life after cancer. Head and neck cancer (HNC) survivors commonly have traumatic treatment experiences and relatively low average PTG scores compared to other cancers. To better understand PTG experiences, we compared HNC survivors' descriptions of positive changes.

Twenty HNC survivors took part in a semi-structured interview looking back on their cancer experience. PTG outcomes were coded. The sample was split into three groups ("lower", "intermediate", "higher" PTG) by PTG inventory scores and number of descriptions of change reported. Participant experiences were compared using a framework matrix.

Greater appreciation of life was reported by almost all participants. Discussion of spiritual change was uncommon. Descriptions of increased personal strength, changes to relationships, and new possibilities reflected more depth of expression and were more reflective among those rated as intermediate/higher PTG. Positive changes in life direction or relationships often related to external factors, e.g., support offered, ability to retire. Some participants struggled to identify or express positive changes.

Increased appreciation of life after HNC may not distinguish between those who have experienced PTG to different extents. Greater understanding of what impacts HNC survivors' ability to reflect upon, express, or achieve other types of positive psychological change is important for informing development of evidence-based interventions.

The COVID-19 pandemic has prompted unprecedented changes in care across the cancer care pathway. New or modified healthcare practices adopted which are of high value, promoting effective, patient-centred cancer care, and improving quality of life and patient experience, should be retained to improve quality and resilience in cancer care.

Cancer Australia conducted a literature review and sought input from cancer control experts and consumers to identify strategies for highvalue changes in cancer care during the pandemic to be embedded into routine practice and improve cancer outcomes.

High-value changes in twelve key elements of cancer care were identified. These include the adoption of innovative models of care to maintain continuity of quality care for cancer survivors, despite social distancing challenges and health system constraints., virtual supportive and palliative care, and telehealth consultations. Strategies to embed high-value models of care include establishment of processes and templates to enable health professionals to implement alternative models of care; utilising standardised methods to screen for, and manage, the holistic needs of cancer patients; improving equity in access to digital health; and communicating transparently with patients to mitigate anxiety regarding changes in care plans.

The pandemic has prompted the adoption of high-value changes to cancer care. Efforts across the cancer control sector are required to embed these changes into routine practice. 

Physical Activity (PA) has been shown to have beneficial effects on various side effects from cancer and its treatment. Direct measure (Accelerometry (Acc)) provides an objective assessment of an individual's PA level. However, it is costly and impractical. In contrast, a selfreported measure (Godin) will have more bias, but is inexpensive and feasible. The aim of this study is to examine the association between PA as measured by Godin and Acc Methods Data were combined from 3 ongoing and completed studies which evaluated Godin and Acc in women with breast cancer (BC) and men with prostate cancer (PC). Demographic, disease, and PA data were extracted from each study. Correlation, Bland-Altman plots, and data exploration were used to explore relationships.

A total of 263 participants (199 BC and 64 PC) had a mean age of 58.6 (12.2) years old, were predominantly Caucasian (n=214, 82%), and had stage 2 disease (39.5%). Radiotherapy was the most common treatment (82.1%) followed by surgery (77.6%). Participants on average were more likely to under-report the amount of light PA (84.4%), and over-report vigorous PA (43.7%). Table 1 shows the discrepancies among Godin and Acc reporting.

More sphincter saving procedures are being performed for rectal cancer resulting in high patient expectations towards their recovery. The majority expects to resume life as from before diagnosis. The reality turns out to be different when they are confronted with the low anterior resection syndrome (LARS). This is characterized by frequent toilet visits, clustering, urgency, and incontinence. The aim of our study was to get insight in the experiences and needs of patients with LARS. Methods A qualitative grounded theory approach was used. Individual semi structured interviews were conducted in which participants were asked to narrate their experiences and needs after their treatment. Patients were recruited through purposive sampling and later through theoretical sampling. Researchers' triangulation was used during analysis.

A total of 28 participants were interviewed until data saturation. LARS was unexpected and patients tried to manage it through trial and error and hoped for improvement. Participants tried to accept the new lifestyle, others pushed their boundaries and some choose for a permanent stoma (again). Participants were also confronted with loneliness because of LARS. The need for information before surgery is varying but they all express the need for profound counselling afterwards.

In conclusion, it is vital that healthcare professionals have a good view of the problems that patients can experience as they have an important role in informing and counseling the patients. 

The objective of this pilot study was to evaluate the change in sexual function following treatment with fractional CO2 laser therapy in BC survivors with GSM. Methods A single arm feasibility study of BC survivors with symptoms of GSM, including dyspareunia and/or vaginal dryness, was conducted. Participants who received three treatments with fractional CO2 laser and four week follow-up were contacted for patient reported outcomes and adverse events at 12 months. Sexual function was measured using the Female Sexual Function Index (FSFI) and Female Sexual Distress Scale Revised (FSDS-R).

A total of 67 BC survivors enrolled, 59 completed treatments and four week follow-up; 39 participated in the 12 month follow-up. The overall FSFI score improved from baseline to four week follow-up (median Δ 8.8, p<0.001). There were improvements at four weeks in all domains of the FSFI (p<0.001 for each) including desire (median Δ 1.2), arousal (median Δ 1.2), lubrication (median Δ 1.8), orgasm (median Δ 1.2), satisfaction (median Δ 1.6), and pain (median Δ 1.6). The FSDS-R score also improved from baseline to four week follow-up (median Δ -10.0; p<0.001) indicating less sexually related distress. The scores of the FSFI and FSDS-R remained improved at 12 months and there were no serious AE reported.

Fractional CO2 laser treatment appears to improve sexual function and decrease distress in BC survivors with GSM. 

Occurring predominantly in working-aged adults, grade II and III diffuse gliomas can have a prolonged, negative impact on quality-of-life, with inevitable progression and mortality. The unmet supportive care needs of this patient group, post-primary treatment, are scarcely understood. We aim to identify their needs, to inform the co-design of a supported selfmanagement programme for adults with grade II and III gliomas.

We are conducting up to thirty, semi-structured interviews with adults with grade II and III oligodendrogliomas and grade II astrocytomas. Recruitment is ongoing (currently n=16). Participants are asked about their experiences of managing the cognitive, physical, psychological, social and functional impacts of the condition. Thematic data analysis is underway.

Initial data suggests that support needs vary greatly depending on tumour type, location and extent of cancer-or treatment-related disability. Common difficulties include management of fatigue, cognitive and functional impairments, seizures and loss of independence. Patients have multiple unmet psychological needs, including anxiety about tumour progression. For many, incapacity to work has emotional, financial and social implications.

Preliminary findings indicate a need for interventions that: address the distinct challenges faced by adult grade II and III glioma patients, accommodate individual needs, and improve patients' ability to access support services.

CRC is prevalent in the developed world, but advances in effective diagnosis and treatments have improved survival rates. Yet CRC survivors experience poor physical and psychological function and suffer long-term gastrointestinal (GI) symptoms. However, current supportive care provision and management options for these important supportive care needs remains unclear. We aimed to identify available interventions offered to CRC survivors to manage GI symptoms and functioning impairments. Methods 1) searches in five electronic databases for studies describing/evaluating interventions to address GI symptoms and functioning in CRC; 2) international survey plus structured interviews with CRC survivors and managing health professionals on current practices and opinions about available interventions and gaps.

We identified 22 interventions for managing GI symptoms and functional outcomes in CRC survivors. Few interventions available for fatigue, bowel and sexual function. CRC survivors revealed having ongoing debilitating problems such as neuropathy, impaired bowel and sexual function and anxiety, few seek professional help and often self-manage their symptoms. Health professionals want methods to monitor and detect these PROs and established clinical pathways to specialist care (e.g. nurse-led clinics, stomal therapists.

Patients seldom seek professional help and few supportive care interventions are routinely offered. Follow-up care for CRC survivors should integrate screening for long-term problems and provide targeted supportive care. CRC is common in the developed world. Advances in diagnosis and treatment have improved survival rates but resulted in a growing population of long-term CRC survivors with unmet needs. Favourable survival rates highlight the need to better understand CRC survivors' experiences of long-term disease and treatment impacts. We aimed to develop a comprehensive survivorship PRO assessment model for CRC. Four databases were searched for: (1) longitudinal studies reporting pretreatment PRO predictors of survival in CRC or prevalence of PROs ≥1y post-treatment (PT); (2) qualitative studies reporting PROs >1y PT. Two reviewers independently assessed eligibility and extracted data. Metasynthesis was used to collate the evidence across studies.

CRC survivors experience ongoing bowel symptoms and function impairments >1y PT. Patients often self-manage symptoms and function impairments. Our model includes six PROs (symptoms; physical, social, psychological, sexual function; relationship impact), three patientreported experiences (supportive care needs, healthcare experience, return-to-work), and six mediating factors (disease stage, age, comorbidity, behaviours, care access, financial toxicity). CRC survivors experience symptoms that can predict survival and impair function long after treatment has completed. Post-treatment CRC care should routinely monitor symptoms and function. Earlier detection and treatment of these problems may improve HRQOL and extend survival. ur model guides comprehensive assessment of PROs in CRC clinical practice and future clinical trials.

Rehabilitation professionals can play an important role in supporting people with metastatic breast cancer (MBC) and optimizing their daily activities. Leisure physical activity (LPA) is important for women with MBC and can help enhance their quality of life. There is little research on LPA in people with MBC from a rehabilitation perspective. The objective of this study was to explore the perspectives and experiences of women with MBC related to LPA.

Our qualitative exploratory study was informed by the interpretive-description approach, which is useful in providing relevant implications for practice-based disciplines. The primary researcher, a physiotherapist, conducted semistructured interviews with 7 women living with MBC. Interviews were transcribed verbatim and analyzed descriptively and thematically.

On average, participants were 48.1 years old and 4.4 years post-MBC diagnosis. Participation in LPA is not a one-size-fits-all experience for people with MBC, but most participants felt LPA was meaningful in their lives and described individual benefits on their psychosocial wellbeing and physical function. From a rehabilitation perspective, several participants voiced concerns over risks of injury and symptom aggravation and described insufficient professional support or guidance on LPA.

In women with MBC, LPA is a personal experience that is strongly linked to psychosocial and physical impacts. Rehabilitation professionals can play a valuable role in addressing barriers and challenges faced by people with MBC related to LPA. 

Biological and precision therapies are transforming treatment of advanced cancer. Although these may lengthen survival, they can cause side-effects which differ from those associated with traditional chemotherapies. Little is known about the experiences of patients who use these therapies. The TARGET study will: (1) explore experiences of cancer patients treated with these therapies; (2) develop an instrument to measure their unmet supportive care needs; and (3) assess prevalence of unmet needs. Methods Phase 1 involves semi-structured interviews with health professionals and cancer patients who use(d) biological or precision therapies, to explore patient experiences and needs. Phase 2 involves identifying and appraising existing instruments for assessing unmet needs in advanced cancer; and selecting one and adapting it (using cognitive interviews) to capture the needs of patients on these therapies. Phase 3 will use the new instrument to survey patients who use(d) these therapies, assessing psychometric properties and: prevalence of unmet needs; factors associated with unmet needs; and associations between needs and quality-of-life.

TARGET commenced 2020. A systematic review of unmet needs instruments is complete. Approvals are in place for data collection. Conclusions TARGET will generate new knowledge and understanding of experiences and needs of patients prescribed biological or precision therapies. Findings will determine the need for additional resources and/or service developments to support this growing population. 

The side-effects of head and neck cancer (HNC) and its treatment can adversely impact survivors' social interactions. We investigated associations between markers of social interaction (trouble with social eating and social contact) and depression and quality-of-life (QoL) among HNC survivors.

We used 12 month follow-up data from Head and Neck 5000. Trouble with social eating and social contact were measured using EORTC QLQ-H&N35 and QoL using EORTC QLQ-C30. Responses were converted into a score of 0-100; a higher social eating/contact score equates to worse problems and higher QoL reflects better QoL. A HADS subscale score of ≥8 was considered significant depression. Associations between tertiles of trouble with social eating and social contact and depression and QoL were assessed using multiple regression. 

We found associations between markers of social isolation and depression and QoL. Interventions to support social interaction among HNC survivors would be of value.

Adjuvant endocrine therapy (AET) substantially reduces risks of recurrence and mortality in breast cancer. However, 20% of women show poor adherence at two years and 50% at five years. In SWEET, we are developing and evaluating an intervention to reduce poor adherence, improve health-related quality-of-life (HRQoL) and reduce long-term recurrence in women with ER-positive breast cancer. Methods Workstream (WS)1 is developing a person-centred, evidence-based, theoretically-informed intervention to support AET adherence. Theoretical underpinnings come from the Common Sense Model and Perceptions And Practicalities Approach. WS2 will assess intervention feasibility and acceptability. WS3 will deliver a RCT of 1018 women, and a process evaluation. WS4 will assess cost-effectiveness. WS5 will inform potential for scale-up across the health service nationwide. WS6 will assess effectiveness in reducing 5year recurrence.

This 80 month programme started May 2020. The intervention includes: a tailored consultation with a trained health professional soon after AET prescription; a theoretically-informed animation; a web application including a symptom monitoring tool, reminders and other support mechanisms; a three-month follow-up telephone consultation to address any emerging concerns; and regular email/ text contact.

SWEET offers potential to improve adherence, reduce recurrences and breast cancer deaths, benefiting patients, the health service and society. It is unclear what factors are associated with higher healthcare use (HU) among colorectal cancer (CRC) survivors. Our study aims: (1) compare CRC-related and non-CRC visits to general practitioners (GP) and medical specialists (MS) by comorbidities, and (2) determine factors associated with HU.

We used data from a German population-based cohort of 1718 stage I-III CRC survivors diagnosed in 2003-2010 who provided information on HU at 5-year follow-up. Multivariable linear regression was used to calculate least square means of CRC-related and non-CRC HU according to Charlson comorbidity index and comorbidity cluster, adjusting for relevant demographic, clinical, and psychological characteristics.

A higher comorbidity level was associated with more CRC-related MS visits and non-CRC GP visits. Besides being strongly associated with non-CRC GP visits, comorbidity cluster was also associated with CRCrelated visits to GP and MS but its association varied by specific cardiometabolic comorbidities. Healthcare use was less dependent on prognostic factors for CRC such as age and tumor stage but was strongly associated with disease recurrence, depression, and emotional functioning. Conclusions Comorbidities, rather than age or tumor stage, was related to HU, suggesting that CRC survivors utilize healthcare mainly for reasons other than cancer 5 years post-diagnosis. Improved communication between primary and tertiary healthcare providers could enhance the medical care of cancer survivors with complex health needs and thereby also reduce healthcare costs. Follow-up care practices vary widely across Canada. We investigated patterns of follow-up visits for prostate cancer survivors after treatment and compared these to survivors of other cancer types.

We identified all persons diagnosed in Nova Scotia, Canada, with an invasive breast, colorectal, gynecologic, or prostate cancer between 2006 and 2013. We linked this population-based dataset to cancer centre, hospital discharge, physicians' billings, and census data. Descriptive statistics were computed for oncologist, surgeon, and primary care use in the follow-up period. Multivariate regression examined total number of visits for each physician type.

More prostate cancer survivors (62.4%) had oncologist follow-up visits than survivors of other cancers (30.2-50.1%). Prostate cancer survivors also had more primary care visits (all and cancer-specific) and surgeon visits than other cancer survivors. For example, breast, colorectal, and gynecological survivors had 56%, 69%, and 56% lower risk of cancerspecific primary care visits, respectively, than prostate cancer survivors. These survivors also had 89%, 88%, and 92% lower risk of cancerspecific surgeon visits, respectively, than prostate cancer survivors.

Oncologist, surgeon, and primary care follow-up visits were higher in prostate cancer survivors than in survivors of other cancers. These data may suggest a high level of unmet need in this population and/or lack of care coordination.

Primary care providers (PCP) can safely and effectively provide followup care after treatment, yet there continues to be high variation in posttreatment care practices. Using a population-based survey, we examined survivors' experiences with PCPs post-treatment.

All Nova Scotia adult cancer survivors, 1-3 years post diagnosis and meeting specific inclusion and exclusion criteria, were identified from the Nova Scotia Cancer Registry. They were mailed an 83-item survey to assess needs across four domains (informational, physical, emotional, and practical) and outcomes across models of care (oncologist, PCP, and shared care). Follow-up reminders were sent at 4 weeks. Descriptive statistics were used to examine and report findings.

Results 1514 survivors responded to the survey (response rate=44.6%). PCP-led cancer follow-up varied amongst survivor groups (2.3-21.3%). Breast cancer survivors reported the highest level of shared care (45.5%). Most survivors (60.0-82.4%) reported their PCP understands their follow-up care

Cannabis is used by some patients suffering from cancer to self-manage undesirable symptoms such as nausea, but little is known regarding how cannabis is used in these patients. To improve patient safety, it is essential to better understand for what reasons cannabis is used and by which routes of administration.

Based on the Joanna Briggs Institute guideline, a scoping review was conducted to map the extent of knowledge regarding cannabis use in cancer patients. A search strategy was conducted in August 2020 in CINAHL, Web of Science, Embase, PsycINFO, PubMed, ProQuest, Google and Google Scholar. Primary studies, reviews and clinical practice guidelines, from 2000-2020, targeting adult cancer patients within dispensaries and oncology settings were selected and extracted independently by two reviewers then subjected to a thematic analysis.

We identified 4752 publications and 153 met the eligibility criteria. Overall, 11 reasons associated with patients' cannabis use were identified (e.g. help emotion management) and 3/11 reasons were also associated with prescription from healthcare professionals (e.g. manage refractory nausea). Finally, 11 routes of administration were identified (e.g. oils).

Future studies that address the care of patients with cancer should consider that cannabis might be use for different reasons (e.g. promotes sleep) and multiple routes of administration for cannabis exist other than pills and sprays. Dysphagia is a common side effect of head and neck cancer (HNC) treatment and can greatly impact on quality of life (QOL). Feeding tube dependence was previously found to be related to reduced QOL. We investigated the association between feeding status and swallowingrelated QOL of HNC patients. 143 patients who finished HNC treatment completed the MD Anderson Dysphagia Inventory. Functional feeding status was scored on the Functional Oral Intake Scale (FOIS). Relationships between these measures and patient and disease factors were analysed. Feeding status was associated with QOL (F(2,140)=35.2, p<0.001). Patients on regular diet (M=80.5±12.9) had better QOL than those on tube feeding (M=63.4±12.5, p<0.001) or modified diet textures (62.4 ±12.6, p<0.001). QOL did not differ between tube-fed patients and those on modified textures. Tumour site was associated with QOL (F(3,137)=4.9, p=0.003). Patients who had nasopharyngeal cancer (M=66.0±14.7) had lower QOL than those who had oral (M=74.3 ±15.4, p=0.02) or laryngeal cancers (M=80.1±13.1, p=0.007). Other patient and disease factors showed weak or no association with QOL. QOL was not different in tube-fed patients and those on modified textures, while patients on regular diet had higher QOL. We should maximise swallow function beyond weaning off feeding tubes, to manage regular textures. There were differences in QOL with different tumour sites. Approach to swallow rehab and support should be differentiated for HNC patients. 

Given increased survival after diagnosis of hematological cancers (HC), we aimed to map current evidence of rehabilitation-related information needs among adults with HC.

This study draws from our larger integrative review characterizing the information needs of adults with HC. Based on a systematic search of bibliographic databases, included studies were coded for various information needs using the typology published by Rutten et al. (2003) . Studies that reported on rehabilitation-related information needs were retained for the current analysis. Mapping of the evidence was conducted using descriptive statistics and directed content analysis based on the typology.

Of the 40 studies included in our integrative review, 14 (35%) reported on rehabilitation-related information needs among adults with HC. There was heterogeneity across studies related to study design, HC diagnoses, time since diagnosis, methods of assessing information needs and geographical region in which the study was conducted. However, consistent themes across this dataset highlighted HC patients' expressed needs for information regarding self-care strategies, nutrition during recovery and expectations for long-term side effects.

There are common rehabilitation-related information needs among adults with HC that should be addressed, particularly in preparation for treatment completion and discharge. Innovations in the delivery of this information throughout the cancer and survivorship trajectory are needed. EDUCA-03 Tachynski, P.

EDUCA-03 Tack, J.

CANCE-24 Taghavi Hagheyegh, A. SURVI-57 Takahashi, T. NUTRI-02 (continued) Takami, S. NUTRI-12 Takenaka, M.  ANTIE-13  Takeuchi, A. OTHER-22 Talevi, V. MUCOS-20 Tam, M. MUCOS-13 Tamura, K.

GERIA-22 Tamura, N. CARDIO-05 Tan PEDIA-11 van den Hurk, C.

ONCOD-06, ONCOD-07, ONCOD-08, ONCOD-12, ONCOD-13 van den Hurk, C. J. G.

SURVI-18 van der Aa, S. van der Linden, M. PSYCH-24 van der Molen, L.

SURVI-10 van der Poel, H.

CARDIO-08 van der Poll, L.

CARDIO-08 van der Velden, W.

MUCOS-05 Van der Vorst, M.

CANCE-24 van der Welden, W.

MUCOS-32 van Eenbergen, M.

SURVI-36 van Groningen, L.

MUCOS-05 Van Hecke, A.

SURVI-41 van Laarhoven, K.

DIGIT-21 van Leeuwen, S.

ORALC-17 van Leeuwen-Bouhuis, K.

1 1 Cross Cancer Institute, Radiation Oncology

C. Redondo Galan 1 , M.Rivas Rodriguez 1 1 University Hospital of Badajoz

UK 2 Academic Primary Health Care Centre, Stockholm Health Care Services

Academic Primary Health Care Centre / Karolinska Institute, Stockholm Health Care Services / Neurobiology, Region

Instituto de Investigación Sanitaria La Fe, Unidad Mixta de Tecnologías de la Información Aplicadas a la Reingeniería de Procesos Socio-Sanitarios (ERPSS)

Two reviewers independently screened for eligibility. Data is being abstracted on study and population characteristics and QoL findings. Study quality will be appraised. If appropriate, meta-analysis will be undertaken. Results Twenty-five papers reporting 19 studies across 10 countries, were identified

Unit of Cancer Survivorship

Germany Authors Presentation Number Aapro, M. ANTIE-06

DIGIT-08, HEMOS-04

CANCE-07, CANCE-22

Assis Pellizzon, A. C. ORALC-08

DIGIT-08, HEMOS-04

PALLIA-02, PALLIA-19, PALLIA-20

CANCE-23, DIGIT-09

ANTIE-14, BIOET-02

CARDIO-06, CARDIO-07, NUTRI-04, NUTRI-06, NUTRI-07

ONCOD-01, ONCOD-06

DIGIT-02, SURVI-30

EDUCA-23

DIGIT-21, MUCOS-05, MUCOS-32

PALLIA-09, PALLIA-10

MODEL-04, ONCOD-06, ONCOD-07, ONCOD-08

DIGIT-08, HEMOS-04

MUCOS-02, MUCOS-03, MUCOS-09, MUCOS-12, MUCOS-23, MUCOS-25, MUCOS-29

MUCOS-06, ORALC-11

PALLIA-09, PALLIA-10

MUCOS-20, MUCOS-31

CANCE-22, CANCE-23, DIGIT-09, DIGIT-14, FATIG-06, NUTRI-08, PALLIA-54

MUCOS-04

CANCE-28, DIGIT-10

EDUCA-17, EDUCA-18, EDUCA-19, FATIG-14, ONCOD-01, ONCOD-06, ONCOD-07, ONCOD-08

PALLIA-02, PALLIA-19, PALLIA-20

DIGIT-02, SURVI-30

FATIG-11

CANCE-03, MODEL-33, NUTRIA-16

OTHER-30

CANCE-24, NUTRI-01, PALLIA-28

CANCE-22, NUTRI-01, PALLIA-15, PALLIA-23

ANTIE-06, EDUCA-19, NUTRI-08

CANCE-28, DIGIT-10, DIGIT-12

FATIG-15, FATIG-16, PSYCH-37

MODEL-21, PSYCH-32

ANTIE-13

NEUTR-06

IMMUN-09

MODEL-15, MODEL-18, OTHER-17

DIGIT-02, MODEL-22, SURVI-30

ANTIE-13

FATIG-15, FATIG-16

CANCE-02, EDUCA-18, FATIG-14, ONCOD-01, ONCOD-15

ANTIE-03

ANTIE-12, IMMUN-02

PEDIA-06

DIGIT-02, MODEL-22, SURVI-30

ANTIE-11

MODEL-22, SURVI-30

OTHER-43, PEDIA-06

BIOET-02

EDUCA-17, EDUCA-18, EDUCA-19, FATIG-14, ONCOD-01

ANTIE-06, EDUCA-19, NUTRI-08

OTHER-30

MODEL-15, MODEL-18

IMMUN-01, ONCOD-17

MODEL-34, NEURO-14

PALLIA-02, PALLIA-19, PALLIA-20, PSYCH-16

DIGIT-14

OTHER-43, PEDIA-06

CANCE-02, EDUCA-17, EDUCA-18

EDUCA-17, EDUCA-18

DIGIT-02, SURVI-30

EDUCA-17, EDUCA-18, FATIG-14, ONCOD-15

PALLIA-02, PALLIA-19, PALLIA-20

PALLIA-02, PALLIA-19, PALLIA-20, PSYCH-16

PALLIA-02, PALLIA-19, PALLIA-20, PSYCH-16

ANTIE-02, FATIG-11

PALLIA-30, PALLIA-49

PALLIA-02, PALLIA-19

PALLIA-16

PEDIA-06

PALLIA-09, PALLIA-10

PALLIA-09, PALLIA-10

PALLIA-09, PALLIA-10

PALLIA-09, PALLIA-10

DIGIT-18

DIGIT-02, SURVI-30

DIGIT-02, SURVI-30

MODEL-34, NEURO-14

MODEL-21, PSYCH-32

DIGIT-02, SURVI-30

PALLIA-30

PALLIA-12, PALLIA-22

DIGIT-08, HEMOS-04

GERIA-13

PALLIA-02, PALLIA-19

CANCE-02, FATIG-14, ONCOD-15

CANCE-07, DIGIT-09, FATIG-06

COVID-01, OTHER-26

PALLIA-35

PEDIA-01

MUCOS-15

GERIA-17

GERIA-19

GERIA-13

HEMOS-06, MODEL-02, NEUTR-06, NEUTR-07, NUTRI-17, OTHER-09, OTHER-31

MUCOS-12, MUCOS-23

PEDIA-01, SURVI-32, SURVI-42

PALLIA-35

CARDIO-06, CARDIO-07, COVID-01, MODEL-26, NUTRI-04, NUTRI-06, NUTRI-07, NUTRI-08, NUTRI-13, OTHER-26

MUCOS-12, MUCOS-23, MUCOS-25

EDUCA-03, MODEL-15, MODEL-18

MODEL-35

MODEL-17, PSYCH-22, PSYCH-25, SURVI-45

CANCE-02, EDUCA-17, EDUCA-18, EDUCA-19, FATIG-14

PALLIA-02, PALLIA-19, PALLIA-20

Publisher's note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations

MODEL-17, PALLIA-30

MUCOS-16 Acknowledgement: We thank Mr. Henry Lam in the literature search

Recent research has shown the benefit of using patient-reported outcomes (PROs) in cancer care. Most PROs are standardized with the same PROs used for every patient but tailored PROs may better reflect patient experience. We surveyed oncologists and a comparison group of mental health providers (MHPs) to compare attitudes towards standard and tailored PROs.

We surveyed oncologists (n=200) and MHPs (n=247) through the Qualtrics' survey company. Participants completed questions on the clinical utility and treatment planning of PROs and on tailoring the items or interpretation of PROs in clinical care. We obtained data for this study from the Behavioral Risk Factor Surveillance System for three consecutive years (2017-2019). Only high-risk individuals with complete data (n=11,714) on all predictor variables and the outcome variable were included in the final multivariable logistic regression models. Results Women (OR: 0.86; 95%CI: 0.76-0.96), individuals with no primary healthcare provider (OR: 0.40; 95%CI: 0.31-0.52), and uninsured individuals (OR: 0.64; 95%CI: 0.46-0.90) were less likely to have undergone lung cancer screening compared to their respective counterparts.

The current study identifies factors that contribute to disparities in lung cancer screening uptake. The findings from this study have important implications for the design of more effective interventions to target the identified subgroups for participation in annual lung cancer screening.SURVI-24 NURSE-LED CONSULTATIONS FOR PATIENTS DIAGNOSED WITH BREAST CANCER OR GYNECOLOGICAL CANCER -A PILOT STUDY

Acute pain poses a great challenge to women with breast cancer undergoing mastectomy. Music therapy that was tailored to the culture of patients has been used to manage pain in different patient populations. However, the cultural elements of music in relation to pain management in the Nigerian care setting especially among women with breast cancer undergoing mastectomy remain underexplored. Thus, this study aims to explore the cultural elements and genre of music suitable for postmastectomy pain among Nigerian women Purposive sampling was used to recruit 17 participants who have undergone mastectomy. Data was collected through in-depth interview at the surgical out-patient clinic and female surgical ward. Data collection was continued till data saturation was reached. Inductive data analysis was used, and the concepts were organized into themes. The mean age of participants was 53.2 ± 13.4. Five main themes emerged from this study; pain experience after mastectomy, music as an embodiment of culture and lifestyle, getting something out of music, perception of music as a therapy for pain management after mastectomy and innovative ways to adopt music therapy. From the participants' experience with pain management in this study, knowledge about music as a form of therapy for pain management remains inadequate. However, they perceived that music that considers cultural elements (language, religion and meaningfulness) would be effective for reducing pain after mastectomy.

C. Akuoko 1 , P. Yates 1 , S. Chambers 1 1 Queensland University of Technology, School of Nursing, Brisbane, Australia Introduction Most women with breast cancer in Ghana are initially diagnosed with advanced disease. Improved treatments have increased survival rates leading to more need for health and supportive care services. Methods Aim to understand the perceived and expressed needs of women with advanced breast cancer (ABC). Women diagnosed with ABC (n=176) attending an outpatient oncology centre between June and July 2019 were assessed for their demographic characteristics, their supportive care and spiritual needs and health and supportive care service use.

Most participants (96.6%) had needs in relation to professional counselling access and finances. Their most prevalent supportive care needs were related to health system and information needs (90.3%-96.6%). Compared to older women (51.7%), younger women (48.3%) had greater psychological (p=.002) and sexuality needs (p<.001) and less religious needs (p=048). Most participants (92.1%) had one or more spiritual need. Many of the available outpatient services were not accessed by the majority of participants (>63%). Conclusions Participants reported high supportive care needs but did not access relevant services. Most participants were unaware of the health and supportive care services available to them or these services were not accessible due to their financial or geological situation. Targeted interventions would assist women with ABC in Ghana to address their supportive care, spiritual and service needs and to access relevant services. My life has no purpose 9.6% 6.1% 84.3% I feel at peace 78.3% 11.3% 10.4% I can't forgive others for wrong they did to me 5.2% 8.7% 86.1% I can't forgive myself for my mistakes 9.6% 11.3% 79.1% Section 2: Questions : yes I don't know no There is some higher power that supports me 91.3% 5.2% 3.5% I have become less interested in thinking about God or religion 9.6% 4.3% 86.1% This is a punishment 5.2% 4.3% 90.5% When I think of God, I feel in peace 95.6% 3.5% 0.9% Praying makes me feel better 88.7% 1.7% 9.6% God has abandoned 1.7% 2.6% 95.7% Conclusions The integration of spirituality in health care requires a clarification of its concept. 

Lymphedema is a common, yet understudied late effect of head and neck cancer (HNC) treatment. The aim of this study is to explore in depth the experience of lymphedema in individual HNC survivors.

Qualitative study with a narrative research approach, using semistructured interviews. Eligible participants had been treated for HNC >1 year ago, and were currently disease-free. We used purposeful sampling to achieve diversity in age, sex, tumor type, and cancer treatment. The interview guide included cancer history, development and current symptoms of lymphedema, information received and 'a typical day'. Interviews were conducted, transcribed verbatim, and coded by two researchers, following the approach according to Braun and Clarke's thematic analysis. Initial findings were discussed with the larger research team until consensus.

Preliminary results after the first six interviews (2 females, 4 males) show a diversity in experiences related to symptom experiences, self-scrutiny, intimacy, self-image, and self-management. Similarities between the participants were found in experienced worries and anxiety at the onset of lymphedema, and their appreciation of received (supportive) care. Table 1 summarizes the characteristics of the participants, and examples of applied codes and exemplary quotes.

This study provides early insights in the diversity of experiences with head and neck lymphedema of individual HNC survivors. Final interpretations will be made once all interviews and analyses have been completed, which is expected by the end of May. 

Over the last decades, living conditions of young breast cancer (BC) survivors have received special attention. This population-based study aimed to identify clinical, social and economic determinants of Health-Related Quality of Life (HRQoL) and describe other living conditions of young long-term BC survivors. Methods Non-metastatic BC women diagnosed between 2006 and 2015, aged 45 years and younger at diagnosis were identified through the French Côte d'Or Breast and Gynecologic Cancer Registry. Participants completed self-report questionnaires including standardized measures (HRQoL, anxiety, depression, deprivation, social support and sexuality); fertility and professional reintegration issues. The determinants of HRQoL were identified using mixed regression model.

In total, 218 BC survivors participated in the survey. The main determinants of poor HRQoL were anxiety, depression, comorbidities, deprivation and menopausal status. Among 72% of women who did not receive information about fertility preservation 38% would have liked to be informed. Finally, 39% of survivors reported a negative impact of BC on their professional activity and in 59% this negative impact still persisted at the time of the survey.

This study showed that BC stage or treatments did not have an impact on young long-term BC survivors HRQOL. Fertility, sexuality and professional reintegration, remained the main issues for survivors. Specific interventions in these population should focus on these issues. 

After cerebral radiotherapy (CRT), long-term cancer survivors are at risk of radiation-induced cavernomas (RIC). Although common, the natural history of RIC is not well described. We report the largest cohort of longterm cancer survivors with RIC, and the first series of long-term surveillance using magnetic resonance imaging (MRI) with highly sensitive susceptibility-weighted imaging (SWI). Methods Eligibility required long-term cancer survivorship, and RIC seen on MRI-SWI. RIC number and size were reported on Baseline and last Follow-up MRI-SWI. MRI-SWI were centrally reviewed. Results 113 cancer survivors were eligible. At CRT, median age was 9.3 years, median dose was 50.4Gy, median time to Baseline MRI-SWI was 17.9 years. Median follow-up from Baseline MRI-SWI was 7.4 years. On Baseline MRI-SWI, 89% of survivors had multiple RIC; >10 RIC in 34%; RIC ≥4mm in 65%. On Follow-up MRI-SWI, 96% of survivors had multiple RIC; >10 RIC in 62%; RIC ≥4mm in 72%. Of the 109 (96%) with asymptomatic, screening-detected RIC, 96% remained free from RIC-related symptoms at 10 years. Only two (2%) required neurosurgical intervention for RIC. No RIC-related mortality. Conclusions RIC are typically asymptomatic: neurological sequelae are infrequent, and neuro-surgical intervention is rare. Serial MRI-SWI reveals RIC to be commonly multiple, and progressive in size and number. We suggest screening MRI-SWI is unlikely to influence longer term intervention for RIC; and asymptomatic RIC are insufficient indication for MRI-SWI surveillance in long-term cancer survivors with past CRT. 

There is currently scarce evidence on the optimal approaches to integrating patient-reported outcomes (PROs) in daily clinical practice. This survey aims to gather oncology practitioners' experiences with implementing PROs in cancer care.

Between Dec 2019 to June 2020, a total of 362 practitioners (physicians 38.7%, nurses 46.7%, allied health professionals 14.6%) completed an online survey to report their experience and barriers to routine PRO collection. The respondents represented 41 countries (Asia-Pacific 42.5%, North America 30.1%, Europe 24%, others 2.2%).

A quarter (25.4%) identified themselves as "high frequency users" who collected PROs from >80% of their patients. Practitioners typically used PROs to facilitate communication (60.2%) and monitor treatment responses (52.6%). The majority reported institutional barriers to implementing PRO collection ( Figure 1 ). Compared with practitioners from high-income countries, more practitioners in low-middle income countries reported not having access to a local PRO expert (P<.0001) and difficulty in identifying the appropriate domains to measure (P=.006). Compared with nurses and allied health professionals, physicians were more likely to perceive disruptions in their clinical care during PRO collection (P=.001) and lack of an effective workflow (P<.0001) as barriers.

The practice of PRO collection among the surveyed practitioners was low. Our findings will be applied in capacity building and guiding further implementation science for PRO collection in cancer care. 

Gynaecological cancer (GC) survivors are reported to have impaired sexual functioning, sexual distress and disruptions in their marital relationships. This presentation describes the protocol of a study examining the effects of a nurse-led sexual rehabilitation intervention on rebuilding sexuality and intimacy for GC survivors in Hong Kong.

An assessor-blind randomised controlled trial will be conducted. A total of 172 women planning for GC operations will be recruited and randomized into intervention or attention control groups. Intervention group will receive a four-session sexual rehabilitation intervention delivered by a trained research nurse. Each session will last for 45-60 minutes, all being individual or couple-based, with the provision of information, cognitivebehavioural therapy and counselling by using motivational interviewing skills. Data will be collected at baseline, one-month, six-month and twelve-month after treatment completion using validated questionnaires and semi-structured interviews.

We hypothesis that the intervention group will demonstrate a significant improvement in sexual functioning and marital relationships, and a significant reduction in sexual distress after the completion of intervention when compared to the control group.

The study findings will have important implications for health services in GC sexual rehabilitation, and the intervention can be applied to other groups of female patients. 

The COVID-19 pandemic has challenged traditional models of long-term follow up for allogeneic stem cell transplant (ASCT) recipients. This essential work needed to continue as the late complications in the ASCT population significantly contribute to long term morbidity and mortality. An innovative virtual model to provide this care was developed at a Canadian Transplant Centre, ensuring quality patient care was maintained while reducing in person contact. Methods All patients in the ASCT survivorship clinic were switched from in person visit to either virtual or telephone follow up by a nurse practitioner (NP). A package was mailed 6 weeks before the visit with appointment time, explanation of virtual visits, lab requisition and guidelines for primary care follow up. A reminder call 5 days before the visit to the patient was done to ensure bloodwork was completed. Results All long-term ASCT patients had a virtual visit with the NP from April 2020 onward. All patients accepted a virtual/telephone visit. Patients who required further in person evaluation were referred to clinic in a timely manner.

Virtual NP lead ASCT clinics are safe, feasible and continue to provide quality patient care. Data collection and evaluation of clinic through patient satisfaction surveys are ongoing.

Patients experience several symptoms and side-effects during and after cancer treatment. A profound symptom burden may affect their adherence to oncological treatment and compromise their quality of life. We replaced the physician-led consultations with nurse-led consultations to provide a systematic symptom management and control for patients with breast-or gynecological cancer during chemotherapy and at follow-up, respectively. The primary aim of this pilot study was to examine the patient's satisfaction of nurse-led consultations.

Patients (n=109) responded to an open-ended questionnaire assessing their experiences with the nurse-led consultations. Results 85.3% were "very satisfied" or "satisfied" (11,9%) with the way their questions were addressed during consultations. The patients received sufficient information e.g on side-effects and valued discussions on selfmanagement strategies. All patients found that the discussed topics were highly relevant. They believed that the nurses applied a holistic approach, and they felt safe and strengthened to cope with their situation. An increasing number of symptoms were managed, for example vagina dryness, hot flushes and sleep disturbances Conclusions Nurse-led consultations for patients with breast cancer or gynecological cancer have been implemented and resulted in a more systematic approach to symptom management and optimal utilization of skills and competencies for both physicians and specialised nurses. Purpose To assess patient and caregiver self-efficacy for managing treatment side effects and caregiver preparedness, and to explore nutrition-related challenges. Methods Individuals with gastrointestinal cancer and their caregivers completed structured surveys and in-depth interviews. Cancer treatment side effects, patient and caregiver self-efficacy, and caregiver preparedness were measured. In-depth interviews explored nutrition-related challenges and supportive care needs. Descriptive statistics were calculated. Interviews were recorded, transcribed verbatim, and analyzed using inductive and deductive thematic analysis. Results 58 individuals with GI cancer (42% female, 97%>55 yrs) and their caregivers (59% female, 85%>55 yrs) completed study activities. Caregivers reported lower self-efficacy for managing side effects (57.25 ±25.82) than patients (70.83±19.12: 10-100 scale). Caregiver preparedness score was 2.27 ± 0.72 (0-4 point scale); problem areas were identified, including emotional needs, fluctuating eating habits, advanced disease progression and making care activities pleasant. Five themes emerged from patient interviews: dietary change, resiliency, control, familial support, individuality. Eight themes emerged from caregiver interviews: preparedness, self-care, discordance of nutrition practices, role reversal, managing patient, dietary awareness, family interaction, patience. Conclusions Nutritional beliefs, behaviors, and challenge were identified as themes for behavioral nutrition interventions and risk assessment for cancer caregivers and survivors. 

Included in this study were 7 LIC/LMICs, 7 UMICs, and 13 HICs. Results indicate that 44.4% of countries with a National Cancer Control Plan currently address survivorship care. Findings also indicate that HICs use survivorship care guidelines more often than those in LIC/LMIC and UMICs. In several areas, there was great variation in survivorship care across countries regardless of income level. Common challenges include issues with workforce availability and training, care coordination, distance, psychosocial support, and lack of focus on follow-up care by healthcare systems.

Findings highlight gaps in the current cancer survivorship practices and provide informative guidance for researchers, providers, and policy makers, in efforts to improve the quality of survivorship care on both a national and global basis. Introduction PROFILES (Patient Reported Outcomes Following Initial treatment and Long term Evaluation of Survivorship) is an infrastructure for measuring patient-reported outcomes (PRO). The aim is to share its best practices and the broad range of achievements. Methods PROFILES started in 2004 and was digitalized in 2010. PRO data are longitudinally collected from diagnosis up to 20 years into survivorship. Measures include e.g. Health-Related Quality of Life (HRQoL), comorbidity, lifestyle (smoking, alcohol, physical activity), sleep and return to work. Results of the PRO assessments are fed back to the patient and health care provider. PROFILES is linked to the Netherlands Cancer Registry. Novel developments are collection of biomarkers, dietary intake and patient-reported symptoms.

The PROFILES system is used in >50 ongoing projects in departments of all Dutch hospitals. It has included >25.000 patients and resulted in >150 scientific publications. However, most important is its clinical and social impact. Examples are changes in clinical decision-making (e.g. negative impact of treatment on HRQoL without survival benefit) and discussion about return to work/ life insurance contracts following cancer.

Population-based PRO evaluation improves cancer care. After many years of pioneering, PRO assessment is now being incorporated in daily practice. The future goal is to better inform patients and health care professionals about using PROs during and after treatment, e.g. in shared decision making. Research will focus on personalized care: who and why this person? 

New treatments and early diagnoses can improve survival rates in breast cancer. Most common side effects in the operated arm after surgery and treatments are muscle pain, limitation of range of motion and lymphedema. Aquatic exercise, such as Deep Water Running, contributes to improve and mitigate these effects, significantly improving the patient's quality of life. Methods 16 breast cancer survivors were recruited and completed 24 Deep-Water Running Group sessions during 12 weeks, with a frequency of 2 sessions per week of one hour. All selected participants were evaluated before and after the training program. Taking measurements on total weight, body mass index, handgrip strength and shoulder range of motion. Mean values were compared using paired t-test, significant values were defined by p < 0,05.

Significantly lower values were found in % fat mass after the intervention (35,59±1,77 kg) than before (36,57±1,8 kg) (p<0.05). Muscular mass presented significantly higher values after intervention (41,78±0,98 kg) than before (40,4±0,95 kg, p<0,05) . Significantly changes after the intervention were also found on the operated arm perimeters (29, 49±0, 68 ; 28, 22±0, 72; p <0.01), handgrip strength (23, 87±0, 72; 17, 95±1, 23; p <0.001), shoulder Flexion (162, 44 ±2, 99; 156, 75±4, 53; p <0.05) and adduction (160, 88±6, 16; 137, 37±8, 2; p <0, 01) .

Deep Water Running may significantly improve body composition, muscle strength and range of motion of the operated arm in breast cancer survivors after 12 weeks of regular training. 

Exercise could lower the risk of cancer recurrence and improve mortality, exercise capacity, physical and cardiovascular function, strength, and quality of life in patients with cancer. This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to determine the effects of exercise on mortality and recurrence in patients with cancer.

We searched for articles published before May 2019 in MEDLINE, CINAHL, the Cochrane Library, Scopus, ProQuest, and PEDro. We included RCTs of exercise interventions, such as resistance exercise and aerobic exercise, in patients with cancer that evaluated the risk of mortality and recurrence. The standardized mean difference with 95% confidence intervals (CIs) was calculated for quantitative indices. The randomeffect model was used as the pooling method.

Of 2868 retrieved articles, 8 RCTs were included in the meta-analysis, with a mean PEDro score of 4.50 (SD = 1.25). Exercise significantly reduced the risk of mortality in patients with cancer and in cancer survivors (risk ratio [RR] = 0.76, 95% CI = 0.40-0.93, I2= 0%, P= .009). Exercise significantly reduced the risk of recurrence in cancer survivors (RR = 0.52, 95% CI = 0.29-0.92, I2= 25%, P= .030).

This study found that exercise has a favorable effect on mortality and recurrence in patients with cancer. However, the effect could not be fully determined due to data insufficiency. 

The PancREatic Cancer and Individualised Supervised Exercise (PRECISE) trial aims to explore the feasibility of delivering supervised exercise in resectable pancreatic cancer. The Covid-19 pandemic has impacted the delivery of cancer trials worldwide. We engaged with individuals with pancreatic cancer to investigate how to optimize the delivery of the PRECISE exercise trial. Methods An anonymous online questionnaire was sent to 160 participants (≥18 years; pancreatic cancer diagnosis), and a focus group was held in May 2020 to examine aspects of trial delivery. For example, when and by whom information on exercise trials should be delivered, frequency and setting of the intervention, and barriers/ facilitators to exercise. Responses were analysed thematically, findings verified and discussed within the research team and subsequent changes made to the trial. Results 19 participants completed the questionnaire and 6 took part in the focus group. 84% had received surgery followed by chemotherapy (n = 21). The majority were female (n = 20, 80%). The most cited barriers to exercise were fatigue (37%), and pain (26%). The majority preferred to receive information regarding enrolment after surgery (63%), with information provided by an exercise specialist (58%). Receiving information on the safety and benefits of exercise was highlighted as a facilitator of participation.

The PPI exercise informed our recruitment strategy to include more detailed information at first contact of the safety and benefits of exercise during treatment for pancreatic cancer. COVID-03, SURVI-27 (continued)