Concordance between Comprehensive Cancer Genome Profiling in Plasma and Tumor Specimens

IntroductionDetection of somatic genomic alterations in the plasma of patients with cancer (“liquid biopsy”) are increasingly being used in the clinic. However, the concordance of alterations identified in liquid biopsies with those detected in cancer specimens is not routinely being determined.MethodsWe sought to systematically compare alterations found by a massively parallel sequencing liquid biopsy assay covering 39 genes (NEOliquid [NEO New Oncology GmbH, Köln, Germany]) with those identified through routine diagnostic testing in a certified central pathology laboratory in a cohort of patients with nonsquamous NSCLC. NEOliquid is based on enrichment of the genomic territory of interest by hybrid capture and is thus capable of detecting point mutations, small insertions and deletions, copy number alterations, and gene rearrangements/fusions in a single assay.ResultsIn a cohort of 82 patients with matched blood/tissue samples, the concordance between NEOliquid and tissue-based routine testing was 98%, the sensitivity of NEOliquid was higher than 70%, and the specificity was 100%. Discordant cases included those with insufficient amounts of circulaating tumor DNA in plasma and cases in which known driver mutations (e.g., isocitrate dehydrogenase (NADP(+)), 1 systolic gene [IDH1] R132H, kinesin family member 5B gene [KIF5b–ret proto-oncogene [RET], or MNNG HOS Transforming gene [MET] exon 14) were found in the plasma but were not interrogated by routine tissue analyses.ConclusionsIn summary, NEOliquid offers accurate and reliable detection of clinically relevant driver alterations in plasma of patients with cancer.     

Machine learning models to prognose 30-Day Mortality in Postoperative Disseminated Cancer Patients

Patients with disseminated cancer at higher risk for postoperative mortality see improved outcomes with altered clinical management. Being able to risk stratify patients immediately after their index surgery to flag high risk patients for healthcare providers is vital. The combination of physician uncertainty and a demonstrated optimism bias often lead to an overestimation of patient life expectancy which can precent proper end of life counseling and lead to inadequate postoperative follow up. In this cohort study of 167,474 postoperative patients with multiple types of disseminated cancer, patients at high risk of 30-day postoperative mortality were accurately identified using our machine learning models based solely on clinical features and preoperative lab values. Extreme Gradient Boosting, Random Forest, and Logistic Regression machine learning models were developed on the cohort. Among 167,474 disseminated cancer patients, 50,669 (30.3%) died within 30 days of their index surgery; After preprocessing, 28 features were included in the model development. The cohort was randomly divided into 133,979 patients (80%) for training the models and 33,495 patients (20%) for testing. The extreme gradient boosting model had an AUC of 0.93 (95% CI: 0.926–0.931), the random forest model had an AUC of 0.93 (95% CI: 0.930–0.934), and the logistic regression model had an AUC of 0.90 (95% CI: 0.900–0.906 the index operation. Ultimately, Machine learning models were able to accurately predict short-term postoperative mortality among a heterogenous population of disseminated cancer patients using commonly accessible medical features. These models can be included in electronic health systems to guide clinical judgements that affect direct patient care, particularly in low-resource settings.     

应用癌症治愈指数评价中国癌症临床水平现状的研究

[目的]评价中国癌症治疗水平的现状。[方法]使用GLOBOCAN 2002数据估计了中国主要癌症（男性18种,女性20种）的粗CC指数（CCC指数）和年龄标化CC指数（ACC指数）及其95％可信区间和四分位间距。CC指数的计算公式为：CC指数=（1-死亡率／发病率）×100。[结果]男性全癌（除外皮肤癌）ACC指数为22．01,女性为33．05。ACC指数与CCC指数在多数部位差别较小。男、女性甲状腺癌的治愈水平均为最好,肝癌最差。男性治疗效果不好的癌症（部位）包括食管、胃、肝、胰、肺、多发性骨髓瘤和白血病。女性治疗效果不好的癌症（部位）包括食管、胃、肝、胰、肺、子宫颈、脑神经系统、多发性骨髓瘤和白血病。[结论]CC指数易于计算,可在生存分析中作为单一指标替代生存率。     

Synopsis of history of American Society for Therapeutic Radiology and Oncology 1958-2008

PURPOSE: To provide a synopsis of the history of the association of radiation oncologists in the United States, currently known as the American Society for Therapeutic Radiology and Oncology (ASTRO), with the occasion of the 50th anniversary of the organization. METHODS AND MATERIALS: The history of ASTRO, from its beginning as the American Club of Therapeutic Radiologists, is the subject of a book that is to be released with the occasion of the 50th Annual Meeting of the Society in 2008. This book was prepared by members of ASTRO's History Committee and History Working Subcommittee. The source material for the book was the archives of the Society and recorded interviews, conducted by members of the subcommittee, of members of the Society and of the past and present Society staff. The book was also based on previously published material. This article used the source material used for the Society anniversary book. RESULTS: This synopsis of the history of the Society will provide a source of reference for anyone interested in the history of the Society from its foundation in 1958 to the present, 2008.     

Effectiveness of Cognitive Restructuring on Intensity of Pain in Cancer Patients: A Pilot Study in Oncology Department of Tertiary Care Hospital

Background: Pain is a most feared symptom among cancer patients. It not only affects physical health but it is a psychological burden and affects overall quality of life in cancer patients. it interferes the activity of daily living and treatment outcome. cognitive restructuring is very useful psychological treatment to reduce pain. Objectives: The purpose of the study was to assess level of pain, evaluate effectiveness of cognitive restructuring on intensity of pain and to find association of pain with demographic variables. Methods: Quasi experimental  study was conducted in oncology department of SKIMS tertiary care hospital. Purposive sampling technique was used to select 22 patients for study group and 22 patients for control group. CBPS and Numerical rating pain scale was used to measure intensity of pain. Data collected by interview method. Results: The results showed significant difference p<0.05 at only  in anxiety,face and activity on CBPS scores. Mean score of NPRS was 27.27% of moderate pain  and severe pain reduced from 63.64 to  to 0.%  in study group after CR. Results revealed Significant association of pain with age, gender and period of illness. Conclusion: Based on findings of the study it is concluded that CR has significant impact in cancer patients  on reducing pain and can ease problems related to pain. CR is an appropriate intervention to reduce the symptoms of cancer patients which has indirect impact on cancer treatment.     

中国东部与中西部地区恶性肿瘤发病率的比较研究

[目的]描述中国东部和中西部肿瘤登记地区恶性肿瘤发病率水平,比较分析东部与中西部发病率差异。[方法]利用2009年中国72个肿瘤登记处(东部44个,中西部28个)的恶性肿瘤发病及人口数据,按地区、性别和城乡分别计算发病率、标化发病率。运用负二项回归模型,以发病数为应变量,地区分类为自变量(中西部为参照),调整年龄、性别和城乡分类计算恶性肿瘤发病率比值及95%可信区间。[结果]2009年中国东部地区恶性肿瘤发病率、中标率与世标率分别为306.07/10万、149.22/10万和194.60/10万。中西部地区的恶性肿瘤发病率、中标率与世标率分别为231.53/10万、139.64/10万和182.27/10万。东部与中西部前6位主要恶性肿瘤相同,分别为肺癌、胃癌、结直肠癌、肝癌、乳腺癌和食管癌,但顺位略有不同。东部的结直肠癌和乳腺癌发病率和标化率均高于中西部地区,肺癌、胃癌、肝癌和食管癌的发病率高于中西部,标化率低于中西部地区。东部男性恶性肿瘤发病率是中西部的1.13倍,发病率差异最大的前3位恶性肿瘤依次为甲状腺癌、前列腺癌和肾癌,发病率比分别为1.89(95%CI:1.64~2.17)、1.66(95%CI:1.52~1.80)和1.42(95%CI:1.30~1.54)。东部女性恶性肿瘤发病率比为1.19(95%CI:1.08~1.31)。差异最大的前3位恶性肿瘤依次为甲状腺癌、肾癌和淋巴瘤,发病率比分别为1.98(95%CI:1.83~2.15)、1.48(95%CI:1.32~1.66)和1.47(95%CI:1.33~1.62)。[结论]中国东部与中西部地区恶性肿瘤发病率存在明显差异,科学评估恶性肿瘤发病率的地域差异可为肿瘤防治研究提供有价值的信息。     

Treatment Adherence in Patients with Lung Cancer from Prospects of Patients and Physicians

Purpose: Adherence to treatment can be defined as the degree to which a patient’s behavior is consonant with medical or health advice he or she receive as part of his treatment regimen. The aim of this study was:  1) to measure the rate of treatment adherence to among patients with lung cancer from the prospect of both patients and physicians, 2) to measure the degree of concordance between the two prospect, and 3) to identify factors related to adherence for both prospect (patients and physicians). Materials and Methods: A total of 250 patients were included in this study. Information about socio-economic characteristics, depressive and anxiety symptoms (Hospital Anxiety and Depression scale), nicotine dependence (Fagerstrom scale), barriers to accessing care, and the level of treatment adherence was collected through interview. Physicians were enquired about disease and treatment variables as well as patients’ level of adherence. Results: From the patient perspective, only 1.2% of patients displayed poor adherence; whereas the corresponding percentage among physicians was 12.4%. The concordance between the two was low: 0.244. The correlation of measurements made on the same individual was found to be equal to 0.14. Barriers to accessing medication (O.R.=2.82, 95% C.I.: 1.01-8.09) was the only risk factor when adherence was self-rated; barriers to accessing medication (O.R.=2.45, 95% C.I.: 1.03-5.86), education equal to 12 years (O.R.=0.33, 95% C.I.: 0.13-0.82) or higher than 12 years (O.R.=0.28, 95% C.I.: 0.08-0.96), nicotine dependence (O.R.=1.41, 95% C.I. 1.17-1.69) and HADS anxiety score (O.R.=1.15, 95% C.I. 1.03-1.30) were the predictors in physicians’ rating. Conclusions: Differences in rating adherence may underpin communication gaps between patients and physicians. Systemic determinants of poor adherence should not be overlooked. A concerted effort by researchers, physicians and policy makers in defining as well as communicating adherence, while removing its barriers should be made.     

2020年中国临床肿瘤学会《食管癌诊疗指南》解读

基于循证医学证据,结合我国食管癌临床病理特点,中国临床肿瘤学会(CSCO)在2019年首次发表了《食管癌诊疗指南》,2020年进行了第二次更新,本文将对该指南的主要内容进行简要解读,以便加深对该指南的理解并更好地指导临床诊疗实践。     

A Clinical Database of Breast Cancer Patients Reveals Distinctive Clinico-pathological Characteristics: a Study From Central China

Background: Breast cancer is the most common malignant tumor in females worldwide. Many differencesexist in clinico-pathological characteristics of breast cancer patients between China and Western countries. Thisstudy aimed to analyze clinico-pathological characteristics of breast cancer from central China. Methods: Clinicopathologicalinformation on breast cancer from three hospitals in central China was collected and analyzed.Results: From 1994 to 2012, 2,525 patients with a median age 50 years were included in this study. The 45-49-yearage group and invasive ductal carcinoma not otherwise specified accounted for the highest proportions (19.1%,480/2,525 and 81.0%, 1,982/2,446). Stages 0-I, II and III accounted for 28.0% (682/2,441), 48.4% (1,180/2,441),and 23.7% (578/2,441), respectively. Distribution of N stage showed that N0 accounted for 53.2% (1,344/2,525),and proportion of N0 rose from 51.1% (157/307) in 30-39-year age group to 64.3% (110/171) in ≥ 70-year agegroup, with an average increase of 2.1% in each age group. Modified radical mastectomy, radical mastectomy,breast-conserving surgery and simple mastectomy were performed for 71.8% (1,812/2,525), 18.0% (454/2,525),5.2% (131/2,525) and 2.6% (66/2,525), respectively. Proportions of breast-conserving surgery in age ≤ 44-yeargroup (68/132, 51.5%) and simple mastectomy in age ≥ 60-year group (57/89, 64.0%) were higher than in the otherage groups. Breast cancers positive for estrogen receptor accounted for 53.0% (1,107/ 2,112). The comparisonsamong this study and other reports showed higher proportion of younger patients, lower proportion of breastconservingsurgery and positive estrogen receptor patients in China than western countries. Conclusions:Clinico-pathological characteristics in this study demonstrated clear differences between the center of Chinathan Western countries. Additional classification systems should be developed to guide grading of early breastcancer more accurately, especially for N0 patients. Invasive ductal carcinoma is a focus for intensive research.     

Effects of Distant Reiki On Pain,Anxiety and Fatigue in Oncology Patients in Turkey: A Pilot Study

Background: Fatigue, stress and pain are common symptoms among cancer patients, affecting the quality oflife. The purpose of the present study was to determine the effect of distant Reiki on pain, anxiety and fatigue inoncology patients. Materials and Methods: Participants in the control group received usual medical and nursingcare during their stay. The intervention group received usual care plus five distant Reiki sessions, one eachnight for 30 min. A face to face interview was performed and patient personal and illness related characteristicswere evaluated using the Patient Characteristics form. Pain, stress and fatigue were evaluated according to anumeric rating scale. Results: The experimental group was predominantly composed of women (71.4%), marriedindividuals (40%), and primary school graduates (40%). The control group was predominantly male (72.7%),married (60%), and primary school graduates (60%). The control group demonstrated greater levels of pain(p=0.002), stress (p=0.001) and fatigue (p=0.001). The Reiki group pain score (p <0.0001), stress score (p <0.001)and fatigue score were also significantly lower. Conclusions: The results of this study indicate that Reiki mayd ecreasepain, anxiety and fatigue in oncology patients     

2016～2018年中国结直肠癌临床实践指南的质量评价

目的了解我国2016年至2018结直肠癌临床实践指南（CPGs）的现状并采用 AGREE China工具对其质量进行评价，为我国规范制定结直肠癌CPGs提供参考并为临床实践提供明确的推荐意见。 方法计算机检索中国知网数据库（CNKI）、万方数据库（Wanfang Data）、维普中文科技期刊数据库（VIP）和中国生物医学文献数据库（CBM）4个中文期刊数据库，搜集我国制定的结直肠癌CPGs，检索时限为2016年1月1日至2018年12月31日。由2位评价员按照纳入与排除标准独立筛选文献和提取资料，采用AGREE China评价纳入的中国结直肠癌CPGs的质量。 结果共纳入10部指南。指南在AGREE China 5个领域平均得分如下：科学性与严谨性为2110％，有效性与安全性为500％，经济性为600％，可用性与可行性为 6397％，利益冲突为0。 结论我国结直肠癌CPGs总体质量不高，大部分缺乏循证医学证据。在今后指南制定中要特别注重指南制定的科学性与严谨性、有效性与安全性和经济性，提高对利益冲突的关注，并及时对指南进行更新修订。     

Ethical Considerations for the Clinical Oncologist in an Era of Oncology Drug Shortages

Shortages of injectable drugs affect many cancer patients and providers in the U.S. today. Scholars and policymakers have recently begun to devote increased attention to these issues, but only a few tangible resources exist to guide clinical oncologists in developing strategies for dealing with drug shortages on a recurring basis. This article discusses existing information from the scholarly literature, policy analyses, and other relevant sources and seeks to provide practical ethical guidance to the broad audience of oncology professionals who are increasingly confronted with such cases in their practice. We begin by providing a brief overview of the history, causes, and regulatory context of oncology drug shortages in the U.S., followed by a discussion of ethical frameworks that have been proposed in this setting. We conclude with practical recommendations for ethical professional behavior in these increasingly common and challenging situations.     

骨肿瘤患者癌因性疲乏与其临床特征的关系研究

目的研究骨肿瘤患者临床特征与癌因性疲乏的相关性。方法回顾性分析998例骨肿瘤患者的临床资料及相关数据,通过横断面研究,以社会支持量表、疲乏Piper量表、记忆症状简易评价表完成调查分析。结果 386例骨肿瘤患者出现癌因性疲乏,其发生率达到38.68%。患者疲乏总分是(3.92±2.07)分:患者行为维度是(4.85±3.12)分、认知/情绪维度是(1.91±1.27)分、情感维度是(4.53±2.48)分、感觉维度是(4.22±2.86)分。骨肿瘤患者社会支持状况评分中,社会支持总分为(37.69±6.11)分,客观支持评分为(10.28±2.62)分,主观支持评分为(19.85±3.41)分,对支持的利用度评分为(7.53±2.11)分。癌因性疲乏患者(n=386)与无癌因性疲乏患者(n=612)单因素社会支持分析显示,社会支持总分、主观支持评分、对支持的利用度评分对比,呈显著差异(P<0.05),客观支持评分对比,不具差异(P>0.05)。Logistic单因素、多因素回归分析显示,出现疼痛、昏睡、咳嗽、体重下降、食欲减退、头晕、排尿不适、气紧、呼吸困难、便秘、感觉悲伤、感觉紧张、焦虑者的癌因性疲乏发生率高于未出现上述症状者(P<0.05)。结论骨肿瘤患者癌因性疲乏的发生,与社会支持、临床症状均有密切关系,针对患者实施个体化治疗,避免不良反应,改善生活质量,同时增加社会支持,帮助患者调整心理状态,从而提高临床疗效。     

Posttraumatic Growth and Social Support in Turkish Patients with Cancer

Posttraumatic growth (PTG) is the experience of positive change that occurs as a result of the struggle withhighly challenging life crises. The need to understand PTG in relation to actual changes in an individual’s life hasrecently been raised. Little is known about the role of social support in the experience of positive outcomes. Thepurpose of this study is to investigate the role of perceived social support in enhancing PTG in cancer patients.This study involved 105 cancer patients. The data were collected using a questionnaire that determined thesocio-demographic features, posttraumatic growth inventory (PTGI) and perceived social support. Participantsreported relatively high levels of PTG and social support. Total perceived social support, support from family, andfriends were significantly positive associated with the development of PTG among cancer patients. Accordingly,the social surroundings of the patient should be informed about the importance of social support and how ithelps the patient; they should be made aware of necessity of social support.