A study of the pattern of hospital admissions in a specialist Phase I oncology trials unit: Unplanned admissions as an early indicator of patient attrition

BackgroundUnplanned hospital admissions (UHAs) in the context of oncology Phase I trials are important, yet rarely reported.MethodsAll patients admitted to the Royal Marsden Hospital Phase I clinical trials unit during February and March of 2005–2007 were included. The patient-, admission- and trial-related variables were collected. Correlations were sought between the occurrence of UHAs and the baseline patient/trial-related characteristics.ResultsOf the 308 admissions involving 177 patients, UHAs constituted 21% of all the admissions and 38% of the total bed occupancy. The majority of UHAs were cancer related (78%) and their occurrence was associated with a significant early patient attrition. Using multivariate analysis, the factors significantly associated with UHAs included age >60 years (RR 2.32, confidence interval (CI)-95% 1.12–4.81), ?3 metastatic sites (RR 3.26, CI-95% 1.54–6.90) and LDH > ULN (RR 2.18, CI-95% 1.06–4.46), with albumin <35 g/dL trending to significance (p = 0.052). The trials that contained cytotoxic chemotherapy incurred disproportionately higher rates of admissions (69.5%) than the trials that did not.ConclusionsUHAs constitute a substantial workload and impact on the speed and cost of, as well as resource allocation in Phase I oncology trials. The majority of UHAs are cancer rather than treatment related. The risk stratification to guide patient selection may help reduce the incidence of UHAs.     

The Impact of Changes in Service Delivery in Patients With Colorectal Cancer During the Initial Phase of the COVID-19 Pandemic

BackgroundThe Coronavirus disease 2019 (COVID-19) pandemic has imposed significant changes in cancer service delivery resulting in increased anxiety and distress in both patients and clinicians. We aimed to investigate how these changes have been perceived by patients diagnosed with colorectal cancer and identify determinants of increased anxiety.Patients and MethodsAn anonymized 32-item survey in the specialized lower gastrointestinal cancer outpatient clinics at a tertiary cancer center in North West England between May 18 and July 1, 2020. Self-reported anxiety was based on the General Anxiety Disorder-7 screening tool.ResultsOf 143 participants who completed the survey (response rate, 67%), 115 (82%) were male, and the median age group was 61 to 70 years. A total of 112 (78%) participants had telephone consultation (83% met needs), and 57 (40%) had radiologic scan results discussed over the phone (96% met needs). In total, 23 (18%) participants were considered to have anxiety (General Anxiety Disorder-7 score ≥ 5), with 7 (5.5%) scoring for moderate or severe anxiety. Those concerned about getting COVID-19 infection, and worried COVID-19 would have effect on their mental health, and affect their experience of cancer care, were most likely to have anxiety (P < .05, multivariate analysis). The majority did not feel they needed support during this phase of the pandemic. Participants felt that friends and family had been very supportive, but less so the primary care services (P < .05).ConclusionsThe findings of this survey suggest that some of the service changes implemented may have already improved the overall experience of cancer care among patients with colorectal cancer at our institute. Reassuringly, the incidence of participants with moderate to severe anxiety levels during the peak of COVID-19 in the United Kingdom was much lower than anticipated. Importantly, patients were much more concerned about their cancer treatment than COVID-19, emphasizing the need to continue to provide comprehensive cancer care even with a “second wave” of COVID-19.     

Gastroenteropancreatic neuroendocrine tumor cancer stem cells: do they exist?

Neuroendocrine tumors (NETs) comprise a broad range of neoplasms that share biological and embryological origin. A deeper knowledge in the underlying molecular biology that results in the development and spread of NETs has allowed the use of novel-targeted therapies against angiogenesis and intracellular pathways, key checkpoints that govern growth, and proliferation of these tumors. Unfortunately, the possibility of cure is still far for patients with advanced stages. Cancer stem cells (CSCs) are present in most solid tumors. Nevertheless, there is limited evidence for the presence of CSCs in NETs. In this review, we will discuss the embryonic origin and possible existence of a gastroenteropancreatic neuroendocrine cancer stem cell. Here, we summarize the body of evidence supporting the presence of active embryological pathways like Notch, Wnt-β-catenin, Hedgehog, or transforming growth factor-β in NETs. New therapeutic approaches in the field of CSCs seem to have a clear role in the treatment of medulloblastomas and basal cell carcinomas, but their future value in other solid tumor types including NETs remains unclear.     

Angiogenesis and ovarian cancer

Ovarian carcinoma is the most important cause of gynaecological cancer-related mortality in Western societies. The age at diagnosis, extent of disease (as expressed by FIGO state), success of primary surgery and the histopathological features of the tumour are important prognostic markers. The majority of patients with ovarian cancer present with advanced disease (FIGO stage III/IV) and in this group of patients the median survival is only three years. New treatment approaches are therefore required to improve outcome in this disease. Angiogenesis, the development of a neovascular blood supply, is a critical step in the propagation of malignant tumour growth and metastasis and represents a promising target. This review will focus on angiogenesis, VEGF biology and the potential value of angiogenic factors with prognostic value in ovarian cancer.     

Surgery of female genital tract tumour lung metastases

IntroductionLung metastases originating from tumors of the female genital tract are rare. Due to this rarity and their variable histology, it has been difficult to compare different patient series.Material and methodsA retrospective study of patients who underwent resection of lung metastases of female genital tract tumors (uterine, fallopian and cervical cancer) during the period from 01/01/1989 to 12/31/2006. Epidemiological, diagnostic and treatment data were collected. Non-parametric tests and the survival analysis were performed using the Kaplan-Meier curves and the log-rank test.ResultsDuring the study period, 27 underwent resection. Mean disease-free interval (DFI) from initial diagnosis to the diagnosis of metastasis was 58 months (1–195 months). Mean survival from the diagnosis of metastasis was 94 months. The overall 5-year survival after diagnosis of metastasis was 84.1%. A second surgery for metastasis was performed on 5 patients (18.5%). Survival after second surgery of metastases was 80.5 months. Five-year survivals from diagnosis of metastasis were: endometrial carcinoma 100%; cervical cancer 62.5%; uterine sarcoma 60%. Adjuvant hormone therapy was prescribed in15 out of 16 patients with endometrial carcinoma. There was a statistically significant difference in survival depending on the histological type and disease free interval.ConclusionSurgical treatment of lung metastases originating from female genital tract tumors (mainly endometrial carcinoma) is associated with a high long-term survival.