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Editor’s Choice : Cancer Screening Among U.S. Medicaid Enrollees with Chronic Comorbidities or Residing in Long-Term Care Facilities
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Abstract: Background: Ensuring appropriate cancer screenings among low-income persons with chronic conditions and persons residing in long-term care (LTC) facilities presents special challenges. This study examines the impact of having chronic diseases and of LTC residency status on cancer screening among adults enrolled in Medicaid, a joint state-federal government program providing health insurance for certain low-income individuals in the U.S. Methods: We used 2000-2003 Medicaid data for Medicaid-only beneficiaries and merged 2003 Medicare-Medicaid data for dually-eligible beneficiaries from four states to estimate the likelihood of cancer screening tests during a 12-month period. Multivariate regression models assessed the association of chronic conditions and LTC residency status with each type of cancer screening. Results: LTC residency was associated with significant reductions in screening tests for both Medicaid-only and Medicare-Medicaid enrollees; particularly large reductions were observed for receipt of mammograms. Enrollees with multiple chronic comorbidities were more likely to receive colorectal and prostate cancer screenings and less likely to receive Papanicolaou (Pap) tests than were those without chronic conditions. Conclusions: LTC residents have substantial risks of not receiving cancer screening tests. Not performing appropriate screenings may increase the risk of delayed/missed diagnoses and could increase disparities; however, it is also important to consider recommendations to appropriately discontinue screening and decrease the risk of overdiagnosis. Although anecdotal reports suggest that patients with serious comorbidities may not receive regular cancer screening, we found that having chronic conditions increases the likelihood of certain screening tests. More work is needed to better understand these issues and to facilitate referrals for appropriate cancer screenings. Keywords: Neoplasms, Medicaid, Mass Screening, Healthcare Disparities, Nursing Homes.Download Full Article |
Editor’s Choice : Clinical and Biochemical Outcomes of High-Risk Prostate Cancer Patients treated with Third Generation Prostate Cryosurgery
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Abstract: Objectives: To report on outcomes after modern-day primary prostate cryosurgery (CS) in D’Amico high-risk (PSA >20 ng/ml, Gleason score ≥8, or tumor stage T2c or T3) localised prostate cancer (PCa) patients treated at a large academic center. Materials and Methods: 730 consecutive cases of total gland prostate CS were reviewed, and 80 men with high-risk disease identified. Clinical data was analyzed, with primary and secondary endpoints being overall survival, cancer-specific survival, biochemical recurrence (BCR), and clinical progression. Results: Median age was 75.8 (55.4-88.1) years, median presenting PSA 20.0 (2.6-236.5) ng/ml, and median Gleason score 8 (6-10). Median follow-up was 49.6 (8.9-159.3) months. There were three PCa related deaths (4%); 34 (43%) and 39 (49%) men had BCR as defined by the Phoenix- and Stuttgart-criteria, respectively; 24 of the 39 (64%) men were re-biopsied. 13 of 80 (16%) had biopsy proven recurrent PCa. Nine (11%) subsequently underwent salvage CS. Six of the 39 (15%) men with BCR had metastatic disease on bone scan; 19 of 34 (49%) men with BCR received anti-androgen therapy, 18 (95%) of whom had also received neoadjuvant hormonal therapy. Conclusions: Prostate CS is a controversial treatment for high-risk patients, and our early experience revealed low cancer-specific mortality and morbidity, with encouraging biochemical and local control rates for these high-risk patients. In our series the incidence of metastases was less than that reported by Bolla et al. post-EBRT and hormones, and we therefore believe that prostate CS be strongly considered for these high-risk patients, and mandate that further study of CS for high-risk disease is warranted. Keywords: Prostate cancer, high-risk, cryosurgery, biochemical recurrence, overall survival, cancer-specific survival.Download Full Article |
Editor’s Choice : Evidence for the Conversion of Docetaxel into 7-Epidocetaxel in Patients Receiving Conventional Taxotere® Based Chemotherapy
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Abstract: Purpose:Epimerization at the C7atom of the baccatin moiety is a common in-vitro pathway for all taxanes, including the natural precursor 10-deacetyl baccatin III and the antineoplastic drugs paclitaxel and docetaxel. To date this in-vitro epimerization of both drugs has been elucidated completely, but epimerization of docetaxel in patients during chemotherapy has not yet described. The goal of this study was to identify the epimer of docetaxel in plasma and urine of taxotere treated patients. Patients and Methods:12 patients suffering from mamma carcinoma, lung cancer or prostate cancer were treated with various docetaxel-based schedules. Blood samples were drawn before start of infusion, at the end of infusion and 20 min thereafter, urine was collected and pooled for 6 hours. Docetaxel and its epimer epidocetaxel were quantified by solid phase extraction and reversed phase HPLC. Results:In 8 of 12 patients epidocetaxel could be quantified in plasma at the end of infusion (range 0.05 – 0.54 µg/ml). 20 minutes later concentrations were below LOQ due to rapid distribution of docetaxel into tissue. In urine, epidocetaxel has been found in 7 of 12 patients (range 0.1 – 0.5 µg/ml). Conclusion: Epidocetaxel is a distinct docetaxel metabolite in man. So our knowledge, this is the first time that quantification of epidocetaxel in blood and urine of chemotherapy patients has been reported. This finding is important for designing of new docetaxel generic drugs and the development of new chemotherapeutic schedules using docetaxel. To date the in-vivo pharmacologic and toxic properties of the epimer remain unclear. Keywords: Docetaxel, epidocetaxel, epimerization, patients, plasma, urine. Download Full Article |
Editor’s Choice : Correlations between Carcinoembryonic Antigen, Epidermal Growth Factor and Leptin in Patients with Non-Small-Cell Lung Cancer
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Abstract: Objectives:Carcinoembryonic antigen (CEA), epidermal growth factor (EGF) and leptin have been reported to be intimately intertwined in lung carcinogenesis.However, few studies have simultaneously examined these proteins in lung cancer and whether a correlation exist among them remains unclear. Here, we compared the levels of CEA, EGF and leptin in non-small-cell lung cancer (NSCLC) patients and controls and evaluated the possible associations among them. Methods:97 patients ranged from 30 to 83 years of age were studied. Serum CEA, EGF and leptin levels were determined following a standard protocol. The relationships between these proteins and clinicopathological factors were evaluated by Wilcoxon rank sum or Kruskal-Wallis H test. Spearman rank-correlation were used to determine the correlations among CEA, EGF and leptin. Co-expression of these proteins in NSCLC tissues was examined by immunofluorescence. Results: Serum CEA and leptin levels in NSCLC patients were significantly higher compared to controls (both P = 0.000), but no statistically significant difference was found for EGF. CEA and EGF were not associated with the tumor-related factors, but leptin was strongly correlated with sex (P = 0.005). Significant correlations among these proteins were found when the patients were categorized into subgroups. Co-expresstion of these proteins was significantly enhanced with lung carcinogenesis. Conclusions:CEA, EGF and leptin may interplay and play vital roles in the pathogenesis of NSCLC. Besides CEA, the leptin levels were also significantly higher in NSCLC patients than in controls. Determination of preoperative leptin levels may prove useful for screening and predicting NSCLC. Keywords: Non-small-cell lung cancer, Carcinoembryonic antigen (CEA), Epidermal growth factor (EGF), Leptin,Immunofluorescence,Correlation.Download Full Article |
Editor’s Choice : Experience with Lexicomp® Online Drug Database for Medication Review and Drug-Drug Interaction Analysis within a Comprehensive Geriatric Assessment in Elderly Cancer Patients
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Abstract: Background: We studied the use of Lexicomp®, an online drug information database, for adequate identification of drug-drug interactions (DDIs) within Comprehensive Geriatric Assessment (CGA) in cancer patients. Materials and Methods: Data of 149 onco-geriatric patients were reviewed. Sixty-three percent participated in an observational study recruiting head and neck cancer patients (H&N-group), 37% in a registry recruiting general oncology patients (GO-group). Baseline drug information was collected by a health professional, through the medical interview within CGA. Drug class usage was quantified and potential DDIs were assessed and categorized (risk rating "C": monitor therapy, "D": consider therapy modification, "X": avoid combination) with Lexicomp®. Results: On average, H&N and GO-patients took 5 and 8 prescription drugs at presentation, respectively. An average of 4 drugs were added in both groups as part of their proposed therapy. Potential DDIs (n=211 H&N; n=247 GO) were detected by Lexicomp® in 64.9% (85.3% "C", 14.7% "D", 0% "X") and 83.6% (83.4% "C", 15.8% "D", 0.8% "X") of H&N and GO patients, respectively, at therapy start. Administration of cancer-therapy-related drugs lead to additional DDIs (n=75 H&N; n=68 GO) in 73.7% and 58.3% of H&N and GO cases, respectively. DDIs occurred mainly with supportive drugs (100% H&N and 83.8% GO). Sixteen percent of potential DDIs were identified with anti-neoplastic drugs in the GO-group. In 28.7% and 60.0% of H&N and GO patients, respectively, at least one drug was not recognized by Lexicomp®. Conclusions: Use of Lexicomp® drug database within CGA is feasible. It could reduce the administration of inappropriate drugs, and in that way improve the quality of patient-individualized therapy. Keywords: Elderly cancer patients, polypharmacy, Comprehensive Geriatric Assessment, Lexicomp® online drug database, drug-drug interactions, safe prescription behavior, cancer treatment.Download Full Article |