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Journal articles on the topic 'Mouth Cancer Chemotherapy'
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Kalavrezos, Nicholas, and Crispian Scully. "Mouth cancer for clinicians part 12: cancer treatment (chemotherapy and targeted therapy)." Dental Update 43, no. 6 (July 2, 2016): 567–74. http://dx.doi.org/10.12968/denu.2016.43.6.567.
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Brown, Carlton G., Susan L. Beck, Douglas E. Peterson, Deborah B. McGuire, William N. Dudley, and Kathleen H. Mooney. "Patterns of sore mouth in outpatients with cancer receiving chemotherapy." Supportive Care in Cancer 17, no. 4 (October 7, 2008): 413–28. http://dx.doi.org/10.1007/s00520-008-0509-y.
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Earlam, S., C. Glover, M. Davies, C. Fordy, and T. G. Allen-Mersh. "Effect of regional and systemic fluorinated pyrimidine chemotherapy on quality of life in colorectal liver metastasis patients." Journal of Clinical Oncology 15, no. 5 (May 1997): 2022–29. http://dx.doi.org/10.1200/jco.1997.15.5.2022.
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PURPOSE Since systemic and regional (HAI) fluorinated pyrimidine chemotherapies offer similar survival benefit in treatment of colorectal liver metastases (CLM), we sought to identify their impact on quality of life (QoL), which might be a useful indicator of treatment preference. METHODS We compared QoL in 135 CLM patients managed by symptom control (n = 49 patients), systemic fluorouracil (5FU)/folinic acid (n = 35), or hepatic arterial floxuridine (FUDR) (n = 51). Full blood count and liver function tests, World Health Organization (WHO) toxicity criteria, and QoL (Rotterdam Symptom Checklist [RSC], the Sickness Impact Profile [SIP], and the Hospital Anxiety and Depression scale [HAD]) were measured monthly in all patients. RESULTS The HAD anxiety score was significantly increased in symptom control compared with chemotherapy patients 1 month after randomization. There was a significant increase in RSC physical score (repeated measures, P = .05), and in scores for sore mouth (P < .01), dry mouth (P < .01), and tingling hands and feet (P < .01) in systemic chemotherapy compared with symptom control patients. Significant QoL differences (repeated measures and Mann-Whitney U [MWU]) between HAI and symptom control patients were not detected. Systemic chemotherapy patients lived for significantly longer (log-rank test, P < or = .0001) with abnormal HAD anxiety, RSC psychosocial, or RSC sore mouth scores compared with HAI patients, but there were no overall survival differences. CONCLUSION Randomization to symptom control only was associated with increased anxiety. QoL with systemic chemotherapy was impaired by side effects. HAI was associated with similar survival to systemic chemotherapy but with better sustained QoL.
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Loprinzi, C. L., C. Ghosh, J. Camoriano, J. Sloan, P. D. Steen, J. C. Michalak, P. L. Schaefer, et al. "Phase III controlled evaluation of sucralfate to alleviate stomatitis in patients receiving fluorouracil-based chemotherapy." Journal of Clinical Oncology 15, no. 3 (March 1997): 1235–38. http://dx.doi.org/10.1200/jco.1997.15.3.1235.
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PURPOSE Stomatitis is a major dose-limiting toxicity of bolus fluorouracil (5FU)-based chemotherapy regimens, despite the use of oral cryotherapy. Pursuant to preliminary data that suggested a sucralfate oral solution could alleviate chemotherapy-induced oral mucositis, we developed a prospective trial to test this contention. PATIENTS AND METHODS A phase III, double-blind, placebo-controlled clinical trial was designed. Patients were entered onto the study at the time of the first cycle of 5FU-based chemotherapy. All patients received oral cryotherapy for 30 minutes with each dose of 5FU. In addition, each patient was randomized to receive either a sucralfate solution or a placebo solution to be used if they developed mouth tenderness or mouth sores. The study solution was to be used four times daily for 7 days starting on the first day of mouth tenderness or mouth sores. Stomatitis scores were determined by health care providers and by patients themselves. RESULTS There was a total of 131 assessable patients entered onto this trial, 50 of whom developed mucositis and used the study medication (27 sucralfate and 23 placebo). There was no suggestion of any difference in stomatitis severity or duration on either protocol arm. CONCLUSION The resultant data from this clinical trial did not support the prestudy hypothesis that sucralfate would be beneficial for the treatment of 5FU-induced stomatitis.
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Khairani, Sondang, Sesilia A. Keban, and Meyke Afrianty. "Evaluation of Drug Side Effects Chemotherapy on Quality of Life (QOL) Breast Cancer Patients at Hospital X in Jakarta." JURNAL ILMU KEFARMASIAN INDONESIA 17, no. 1 (April 24, 2019): 9. http://dx.doi.org/10.35814/jifi.v17i1.705.
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Breast cancer is the number one cancer type discovered at women in the world. Most causes are genetic factors and hormonal factors. One cancer treatments with chemotherapy. Chemotherapy drugs active in cells dividing and reproducing, but cells normally to be affected by chemotherapy and side effects from chemotherapy drugs affect quality of life. The aim of the study to evaluate side effects of chemotherapy drugs on the quality of life of breast cancer patients. Sampling technique observational prospective breast cancer patients with completed the chemotherapy cycle from September 2017 to April 2018 with descriptive analysis and statistics by looking correlation between drug side effects and Quality of Life (QoL). Results of the study were side effects of fatigue 100%, nausea 67,5%, vomiting 60%, no appetite 63,75%, fever 42,5%, joint pain 43,75%, diarrhea 16,25%, difficulty swallowing 16,25%, allergies 5%, itching 1,25%, mouth sores 3,75%, swollen right hand 1,25%, constipation 3,75%. QoL results are physical 6,2%; psychology 5,3%; social 4,9%; spiritual 6,8%. Results of Sperman test showed no correlation between the side effects of chemotherapy and QoL P> 0,05. This study shows that there is no relationship between the side effects drug chemotherapy and QoL in breast cancer patients.
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El –Housseiny, Azza, Susan Saleh, Ashraf El –Masry, and Amany Allam. "Assessment of Oral Complications in Children Receiving Chemotherapy." Journal of Clinical Pediatric Dentistry 31, no. 4 (July 1, 2007): 267–73. http://dx.doi.org/10.17796/jcpd.31.4.cq752m6173142r28.
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The aim of this study was to assess the early oral complications in pediatric patients receiving chemotherapy. An interview and oral examination was conducted on 150 pediatric cancer patients receiving standard dose chemotherapy. Results showed that oral pain and dry mouth were the most frequent patients' complaints. The prevalences of chemotherapy-induced oral mucositis and oral infections were relatively high. The chemotherapeutic antimetabolites were the most frequently associated with oral complications than other types of chemotherapy. The present results indicate that the oral complications among patients receiving chemotherapy are common
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Yang, James Chih-Hsin, Vera Hirsh, Martin Schuler, Nobuyuki Yamamoto, Kenneth J. O'Byrne, Tony S. K. Mok, Victoria Zazulina, et al. "Symptom Control and Quality of Life in LUX-Lung 3: A Phase III Study of Afatinib or Cisplatin/Pemetrexed in Patients With Advanced Lung Adenocarcinoma With EGFR Mutations." Journal of Clinical Oncology 31, no. 27 (September 20, 2013): 3342–50. http://dx.doi.org/10.1200/jco.2012.46.1764.
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Purpose Patient-reported symptoms and health-related quality of life (QoL) benefits were investigated in a randomized, phase III trial of afatinib or cisplatin/pemetrexed. Patients and Methods Three hundred forty-five patients with advanced epidermal growth factor receptor (EGFR) mutation–positive lung adenocarcinoma were randomly assigned 2:1 to afatinib 40 mg per day or up to six cycles of cisplatin/pemetrexed. Lung cancer symptoms and health-related QoL were assessed every 21 days until progression using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30 and Lung Cancer-13 questionnaires. Analyses of cough, dyspnea, and pain were preplanned, including percentage of patients who improved on therapy, time to deterioration of symptoms, and change in symptoms over time. Results Questionnaire compliance was high. Compared with chemotherapy, afatinib significantly delayed the time to deterioration for cough (hazard ratio [HR], 0.60; 95% CI, 0.41 to 0.87; P = .007) and dyspnea (HR, 0.68; 95% CI, 0.50 to 0.93; P = .015), but not pain (HR, 0.83; 95% CI, 0.62 to 1.10; P = .19). More patients on afatinib (64%) versus chemotherapy (50%) experienced improvements in dyspnea scores (P = .010). Differences in mean scores over time significantly favored afatinib over chemotherapy for cough (P < .001) and dyspnea (P < .001). Afatinib showed significantly better mean scores over time in global health status/QoL (P = .015) and physical (P < .001), role (P = .004), and cognitive (P = .007) functioning compared with chemotherapy. Fatigue and nausea were worse with chemotherapy, whereas diarrhea, dysphagia, and sore mouth were worse with afatinib (all P < .01). Conclusion In patients with lung adenocarcinoma with EGFR mutations, first-line afatinib was associated with better control of cough and dyspnea compared with chemotherapy, although diarrhea, dysphagia, and sore mouth were worse. Global health status/QoL was also improved over time with afatinib compared with chemotherapy.
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Korytova, L. I., V. P. Sokurenko, E. A. Maslyukova, A. V. Meshechkin, N. D. Oltarzhevskaya, M. A. Korovina, I. V. Gusev, A. D. Kuznetsov, V. G. Krasnikova, and E. M. Obuhov. "EVALUATING THE EFFECTIVENESS OF THE COMBINED TREATMENT OF PATIENTS WITH COLORECTAL CANCER, BREAST CANCERAND CANCER OF THE FLOOR OF THE MOUTH USING A STERILE HYDROGEL MATERIAL "KOLEGEL 5-FTUR"." Russian Journal of Biotherapy 14, no. 4 (December 30, 2015): 99–103. http://dx.doi.org/10.17650/1726-9784-2015-14-4-99-103.
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The article is devoted to the effectiveness evaluation of the use of sterile material «Kolegel 5-ftur» on the basis of sodium alginate with 5-fluorouracil, as of shape of disk, in the course of chemoradiotherapy in patients with rectal cancer, breast cancer and cancer of the floor of the mouth. The study group included 38 patients: 19 patients diagnosed with CRR, 10 patients -BC, 9 patients - a cancer of the mouth floor. The study used a hydrogel material «Kolegel 5-ftur» during chemoradia- tion therapy for histologically confirmed diagnosis of a malignant tumor. The effectiveness of the combined treatment is proved by the following criteria: local control of the tumor, the analysis of toxicity and immediate effect. Thus, the use of hydrogel materials «Kolegel-5-ftur» in group of patients with primary malignant tumor localization in the floor of the mouth, with the aggressive chemotherapy provided enhancing the effectiveness of therapy.
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CAETANO, Rafael da Silva, Paula Gabrielle de CASTRO, Paulo Henrique de Souza CASTRO, Alexandre Meireles BORBA, Álvaro Henrique BORGES, and Luiz Evaristo Ricci VOLPATO. "Limitation of mouth opening after radiotherapy for head and neck." RGO - Revista Gaúcha de Odontologia 64, no. 1 (March 2016): 24–29. http://dx.doi.org/10.1590/1981-863720160001000032923.
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ABSTRACT Objective: To evaluate the ability to open the mouth in patients undergoing radiotherapy for head and neck and the variables related to this limitation. Methods: 32 patients were evaluated six months after completion of radiotherapy sessions to treat cancer in the head and neck. The maximum mouth opening was measured using digital calipers and its association with gender, age, smoking, alcohol consumption, tumor location, chemotherapy and surgery were analyzed using the Mann-Whitney and Kruskal-Wallis tests at a level of significance of 95%. Results: The mean age of patients was 60.44 years; 87.5% were male; 81.2% were smokers; 65.6% regularly consumed alcohol. The average mouth opening was 43.17 mm and seven (21.9%) patients had trismus. The most common locations of the tumors were the tongue (31.3%) followed by the larynx and vocal folds with five (15.6%) each. No association was found between limited mouth opening and the other variables. Conclusion: In this sample, 21.9% of patients had trismus six months after completing radiotherapy. The variables gender, age, smoking habits and alcohol consumption, tumor location, previous surgery and adjunctive chemotherapy were not associated with limited mouth opening.
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Wilson, S. Darsana, Chitra C. Nair, Christy Johns, Christy Mathew, Dani Joseph, and Precilla DSilva. "A Correlational Study on Taste Alterations and Quality of Life Among Cancer Patients." Journal of Health and Allied Sciences NU 11, no. 03 (April 15, 2021): 147–53. http://dx.doi.org/10.1055/s-0041-1726574.
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Abstract Introduction One of the major problems faced by the world today is cancer. Cancer is an abnormal growth of cells. Chemotherapy, surgery, and radiation therapy are the treatment regimen for cancer. Prolonged use of chemotherapy drugs can cause different side effects such as alopecia, weight loss, sexual dysfunction, mood swings, and the most important one is taste alterations. The aim of the study is to determine the taste alterations (TAs) and quality of life (QOL) among cancer patients who have undergone three cycles of chemotherapy. Methods The approach used is descriptive survey design. The sample comprised 62 cancer patients selected by convenient sampling. The tool used was baseline proforma, University of Washington Quality of Life (UW-QOL) questionnaire version 4.1, chemotherapy-induced taste alteration scale (CiTAS). Results The majority of the patients belonged to the age group of 41 to 50 years (37.09%) among whom 40% were females. The majority of the patients were not diagnosed with any other disease (91.9%). Around 80.6% of patients reported to have sore mouth, out of whom 45.2% maintained oral care by brushing teeth. The most commonly seen type of tumor was head and neck (37.1%) whereas the tumor type genitourinary was the least seen (3.2%). The majority of the patients had stage II cancer (53.2%) and about 62% of them did not have metastasis. There is significant association with selected demographic variables and QOL (sore mouth, oral care, and tumor type). There is also a significant association with selected demographic variable and TAs, (oral care and tumor type) and there is a negative correlation between TAs and QOL. Conclusion Identification of the severity of TA helps in providing alternative measures to improve the taste buds which may help in improving the QOL.
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Ivanova, Kristīne, and Marija Avota. "Antineoplastic Drugs: Occupational Exposure and Side Effects." Proceedings of the Latvian Academy of Sciences. Section B. Natural, Exact, and Applied Sciences. 70, no. 5 (October 1, 2016): 325–29. http://dx.doi.org/10.1515/prolas-2016-0049.
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Abstract Due to their adverse effects, antineoplastic drugs (cancer chemotherapy drugs) are considered as a potential health risk for nurses and nursing assistants. The aim of this study was to review and summarise information about acute side effects of antineoplastic drugs in two major cancer centres in Latvia. In total 51 nurses and nursing assistants participated in the study, all working in chemotherapy ward at least for 12 months. The research was conducted in Pauls Stradiņš Clinical University Hospital and Rīga East University Hospital, Oncology Centre of Latvia. 56.86% of respondents reported at least one side effect since working in the department of chemotherapy (DC). Headache was the most common acute side effect (37.25%), followed by irritation of eyes (25.49%) and irritation of skin (19. 60%). Headache (p = 0.021), dizziness (p = 0.018), irritation of mouth and throat (p = 0.043), and irritation of eyes (p = 0.004) had statistically significant positive association with years of working in DC, suggesting that those working for longer time in DC are more likely to have headache, dizziness, irritation of mouth, throat and eyes.
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Milazzo, John, Mirseyed A. Mohit-Tabatabai, George J. Hill, Suresh Raina, Anangur Swaminathan, Nae K. Cheung, Kumar Dasmahapatra, and Benjamin F. Rush. "Preoperative intra-arterial infusion chemotherapy for advanced squamous cell carcinoma of the mouth and oropharynx." Cancer 56, no. 5 (September 1, 1985): 1014–17. http://dx.doi.org/10.1002/1097-0142(19850901)56:5<1014::aid-cncr2820560506>3.0.co;2-9.
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Ishii, A., Y. Korogi, T. Hirai, R. Nishimura, R. Murakami, I. Ikushima, K. Kawanaka, M. Shinohara, and Y. Yamashita. "Intraarterial infusion chemotherapy and conformal radiotherapy for cancer of the mouth: prediction of the histological response to therapy with magnetic resonance imaging." Acta Radiologica 48, no. 8 (October 2007): 900–906. http://dx.doi.org/10.1080/02841850701501741.
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Background: Although intraarterial chemotherapy has been used to treat head and neck cancers, some cases have shown poor response. If we can predict the response to this therapy on MRI, individual treatment plans may be altered to the most appropriate form of treatment. Purpose: To evaluate whether MRI can predict the histological response to preoperative chemoirradiation in patients with cancer of the mouth. Material and Methods: This study comprised of 29 consecutive patients with 30 oral cancers. All patients underwent tumor resection after intraarterial infusion chemotherapy and conformal radiotherapy. We compared the margin of the tumor, the presence of bone invasion, tumor area, and volume on pre- and post-treatment MRI with histological responses. Results: Eighteen lesions showed an excellent response, nine exhibited a good response, and three a poor response. Only the tumor area on pretreatment T1-weighted images and the tumor area and volume on pretreatment enhanced T1-weighted images were significantly correlated with the histological response ( P = 0.039, 0.008, and 0.016, respectively); smaller cancers showed better responses. The other factors were not significantly correlated with the histological responses. Conclusion: MRI parameters, excluding initial tumor area and volume, were not predictive of the histological response of oral tumors to preoperative treatment.
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Yunus, Barunawaty. "Efek samping terapi radiasi penderita kanker kepala dan leher pada kelenjar saliva." Journal of Dentomaxillofacial Science 7, no. 1 (April 30, 2008): 57. http://dx.doi.org/10.15562/jdmfs.v7i1.194.
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Nasopharyngeal cancer has different malignancy types, based on its location. Themost frequent type of nasopharyngeal cancer is carcinoma of squamous cell whichhappens on cells inside nose, mouth, and throat. The rare types happened such assalivary gland tumor, lymphoma, and sarcoma. There are three main therapies totreat nasopharyngeal cancer; they are radiation therapy, surgery, and chemotherapy.The main treatment is radiation therapy or surgery and chemotherapy or combinationboth of them. Chemotherapy is often conducted as an additional treatment.Combination treatment between those three treatments optimally can be used fornasopharyngeal cancer patient based on the location and disease stadium. Radiationtherapy on nasopharyngeal cancer can caused some side effects, such as mucositis,salivary gland dysfunction, taste sense dysfunction and malnutrition, tooth disorders,bone transforming, cutaneous transforming, nerve disorders, decreasing ofintellectual, lost of hearing sense, complication of malignant cancer caused byradiation, and intracranial bleeding.
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Xie, Congying, Meng Su, and Xiance Jin. "Apatinib as a salvage treatment in gynecologic cancer patients failed from two or more lines of prior chemotherapy." Journal of Clinical Oncology 35, no. 15_suppl (May 20, 2017): e17009-e17009. http://dx.doi.org/10.1200/jco.2017.35.15_suppl.e17009.
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e17009 Background: The aim of this study was to evaluate the efficacy and safety of apatinib, an oral VEGFR2 inhibitor, in the treatment of advanced cervical and ovarian cancer patients who failed from two or more lines of chemotherapy. Methods: The advanced cervical and ovarian cancer patients, who experienced two or more lines of chemotherapy and treated with apatinib from April 2015 to January 2017, were retrospectively reviewed. All eligible patients received continuous apatinib treatment until disease progression, death, or intolerable toxicity. Survival and toxicities outcome were evaluated by Kaplan-Meier method and according to NCI-CTC4.0. Results: Twenty-six patients were eligible (cervical cancer:12 and ovarian cancer:14). After dose adjustment, 14 patients (53.8%) received 500 mg daily of apatinib, 8 patients received 250mg, 3 received 425mg and 1 received 675mg daily. The median progression-free survival (PFS) of cervical cancer and ovarian cancer were 8 months (95%CI:3.83-12.17) and 4 months (95%CI:1.57-6.44), respectively. Objective response rates in cervical cancer and ovarian cancer were 50% and 50%, respectively. Disease control rates were 100% for cervical cancer and 71.4% for ovarian cancer. Complete response was not observed in either cervical cancer or ovarian cancer. A 52-year old patient with recurrent ovarian cancer, experienced two lines of chemotherapy failure, was orally administered with apatinib at a dose of 250mg daily from November 2015, got partial response (PR) after one month, PFS have not yet reach. A 43-year old female patient with advanced cervical cancer, experienced three lines of chemotherapy failure, was orally administered with apatinib at a dose of 250mg daily from September 2015, got PR with a PFS of 14 months. The toxicities associated with apatinib treatment was generally acceptable with 8 patients developed grade 3/4 toxicity. The most common adverse events in this study were hypertension(n = 17), hand-foot syndrome(n = 24), and mouth mucositis(n = 20). Conclusions: Apatinib monotherapy showed promising efficiency with tolerable toxicity for advanced/recurrent cervical and ovarian cancer patients who failed from two or more lines of chemotherapy.
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Brown, Carlton G., Deborah B. McGuire, Douglas E. Peterson, Susan L. Beck, William N. Dudley, and Kathleen H. Mooney. "The Experience of a Sore Mouth and Associated Symptoms in Patients With Cancer Receiving Outpatient Chemotherapy." Cancer Nursing 32, no. 4 (July 2009): 259–70. http://dx.doi.org/10.1097/ncc.0b013e3181a38fc3.
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Da Ponte, G., J. Rato, C. Pinto, M. Lobo, and S. Ouakinin. "Bruxism as a Consequence of Chemotherapy?" European Psychiatry 41, S1 (April 2017): S668. http://dx.doi.org/10.1016/j.eurpsy.2017.01.1140.
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IntroductionBruxism is a syndrome with uncertain etiology but with proposed factors: psychosocial, peripheral and central. Treatment is also controversial and one of the options focuses in GABA theory and regularization of ion channels. Xelox (capecitabine + oxaliplatin) and bevacizumad is indicated for metastatic colorectal cancer, being oxaliplatin the most neurotoxic agent (acute syndrome and/or a chronic sensory neuropathy). Acute neurotoxicity is very frequent and it is a sensory and/or a motor toxicity (as tongue tingling or jaw spams). The proposed pathogenesis – neuronal hyperexcitability due to alterations of voltage-gated ion channels – is supported by mechanism of action of some treatments.Objectives and AimsReview different causes of bruxism.MethodsDescription of a clinical case.ResultsThis is a story of 76-years-old man in treatment for metastatic colon cancer that developed toxicity: nauseas (treated with haloperidol), bruxism and gingival atrophy. He was referred to psycho-oncology by involuntary movements of mouth and trunk. The patient complained of sadness, anhedonia and insomnia since recurrence of cancer and related the movements with CT. At observation he was anxious, tearfulness and agitated. He was treated for a depressive episode, but the doubt remained about involuntary movements: haloperidol was a confounding factor for oxaliplatin acute neurotoxicity, also aggravated by psychic and peripheral factors.ConclusionsThe authors believe that bruxism is linked to CT in a very complex relation that includes psychic, peripheral and central factors. Psychiatrists need to keep attention to the patient as a whole, not being seduced by easy answers like psychosocial factors.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Kris, M. G., R. J. Gralla, R. A. Clark, and L. B. Tyson. "Dose-ranging evaluation of the serotonin antagonist GR-C507/75 (GR38032F) when used as an antiemetic in patients receiving anticancer chemotherapy." Journal of Clinical Oncology 6, no. 4 (April 1988): 659–62. http://dx.doi.org/10.1200/jco.1988.6.4.659.
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GR-C507/75 (GR38032F) antagonizes the 5-HT3 (serotonin) receptor and prevents cisplatin-induced emesis in animals. In this dose-ranging trial, 44 patients with cancer receiving chemotherapy known to produce nausea and vomiting (including cisplatin, cyclophosphamide, and doxorubicin) received three intravenous (IV) infusions of GR-C507/75 every two hours beginning 30 minutes before chemotherapy. Ten dosage levels were explored, ranging from 0.04 mg/kg to 0.35 mg/kg in each of the three infusions. Toxicities were mild and included sedation, dizziness, headache, transient elevations of SGOT or alanine aminotransferase (ALT), and dry mouth. No akathisia or acute dystonic reactions were observed. Antiemetic effects were seen in patients receiving cisplatin at 120 mg/m2. GR-C507/75 can be safely administered on this schedule at IV dosages up to 0.35 mg/kg in patients receiving chemotherapy. Further studies of this agent at higher dosages and by different schedules are appropriate.
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Lyanova, A. A., L. Yu Vladimirova, E. M. Frantsiyants, I. V. Neskubina, M. A. Engibaryan, N. A. Abramova, I. L. Popova, et al. "Dynamics of changes in type 1 and 2 insulinlike growth factors in the blood of patients with oral squamous cell cancer after targeted therapy with cetuximab." Malignant tumours 11, no. 1 (July 26, 2021): 29–36. http://dx.doi.org/10.18027/2224-5057-2021-11-1-29-36.
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Objective. Studying the blood levels of type 1 and 2 insulin-like growth factors in patients with squamous cell carcinoma of the tongue and mouth floor mucosa depending on the therapy effect.Materials and Methods. The study included data from 30 patients with squamous cell carcinoma of the tongue and mouth floor mucosa T3–4N0–1M0 who received chemotherapy cycles together with targeted therapy with cetuximab. Twenty non-cancer donors were examined as well. Depending on the therapy effect, patients were divided into two groups: sensitive and resistant ones.Results. Initial levels of IGF-1 and IGF-2 in the blood serum of patients prior to chemotherapy and targeted therapy with cetuximab were lower than the levels in donors by 53.5 % and 20.3 %, respectively. After chemotherapy and cetuximab therapy, patients with sensitivity to the treatment showed normalization of IGF-1 and its significant increase compared to the initial levels — by 87 %. Levels of IGF-2 were not statistically significantly different from the initial levels and were 32.5 % lower than in donors. The IGF-1 / IGF-2 coefficient was 58 % higher than the initial value.Conclusions. Chemotherapy and cetuximab therapy normalized levels of IGF-1 in patients with sensitivity to the treatment which was demonstrated by an increase in IGF-1 up to the normal blood levels in effective treatment.
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Nicolatou-Galitis, Ourania, and Amanda Psyrri. "Trismus and reduced quality of life in patients with oral squamous cell carcinoma who received postoperative radiotherapy alone or combined with chemotherapy." Journal of Clinical Oncology 35, no. 31_suppl (November 1, 2017): 222. http://dx.doi.org/10.1200/jco.2017.35.31_suppl.222.
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222 Background: Patients, who receive radiotherapy (RT) for head and neck cancer, develop chronic functional abnormalities and reduced mouth opening-trismus, surviving with reduced quality of life (QoL). We aimed to study trismus and QoL in patients with oral cancer, who received post-operative radiotherapy or chemoradiotherapy. Methods: Patients, who receive radiotherapy (RT) for head and neck cancer, develop chronic functional abnormalities and reduced mouth opening-trismus, surviving with reduced quality of life (QoL). We aimed to study trismus and QoL in patients with oral cancer, who received post-operative radiotherapy or chemoradiotherapy. Results: Mean RT dose was 64.3 Gray. Six patients received chemoradiotherapy. Severe mucositis, pain and xerostomia were recorded in 6 and 5 patients respectively. MMO was reduced in all patients. The mean MMO (34 mm) reached the level of trismus. The total number of symptoms increased from 3.1 to 6.3 in C-30 and from 3.1 to 8.8 per patient in the H/N35. Severe fatigue, pain, limitations at work, weakness, sad feelings, family problems, sleeping problems, anorexia, financial difficulties, tense/irritable, constipation, nausea, vomiting and depression were most often reported with C-30. Most patients reported poor to moderate quality of life. Severe oral, jaw and neck pain, swallowing problems, taste alterations, sticky saliva, dry mouth, coarseness, dental problems, feeling sick and reduced interest in life/sex were the most common symptoms reported with N/H35. Conclusions: The observed trismus, the 2- to 3-fold increase of symptoms and poorer quality of life highlighted the need for support of oral cancer patients, who receive postoperative radiotherapy or chemoradiotherapy. Reduced systemic health, financial difficulties and family problems could be some of the main reasons for the inadequate compliance of our patients to the study, as shown by others, too. The strength of our study was the homogeneous group of patients: all had oral squamous cell carcinoma and all received post-operative radiotherapy or chemoradiotherapy. The small number of patients represents a weakness.
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WAECHTER, Janine, Cristina Braga XAVIER, Gislene CORRÊA, Eduardo de Freitas GOMES, and Romeu Belon FERNANDES FILHO. "Oral and maxillofacial rehabilitation of a patient suffering from intraosseous adenoid cystic carcinoma." RGO - Revista Gaúcha de Odontologia 65, no. 2 (June 2017): 168–73. http://dx.doi.org/10.1590/1981-863720170002000122977.
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ABSTRACT Treatment of cancers of the head and neck may provoke sequelae that affect the quality of life of patients during and after treatment. Mouth-sinus communication resulting from partial or total surgical resection of the palate leads to the patient experiencing dysphagia, dysphonia and trismus, which can lead to social isolation of the individual. As a result, the work of the dental surgeon, together with the multidisciplinary team caring for cancer patients, is fundamental and can help with the diagnosis, assist in the management of chemotherapy and radiotherapy complications and enable postsurgical rehabilitation. The present study reports the case of a patient with adenoid cystic carcinoma in the right maxilla, who underwent a partial maxillectomy, the resulting sequela being mouth-sinus communication. The dental treatment was performed at the Hospital of the Federal University of Pelotas preoperatively, during and after treatment. At this time the patient is rehabilitated with an obturator prosthesis and is being monitored by the dental team and the head and neck surgeon.
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Ellis, Georgiana K., Robert B. Livingston, Julie R. Gralow, Stephanie J. Green, and Tove Thompson. "Dose-Dense Anthracycline-Based Chemotherapy for Node-Positive Breast Cancer." Journal of Clinical Oncology 20, no. 17 (September 1, 2002): 3637–43. http://dx.doi.org/10.1200/jco.2002.12.113.
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PURPOSE: Theoretical considerations and clinical experience suggest that dose-dense chemotherapy may be superior to other approaches using the same drugs. We studied a dose-dense combination of doxorubicin and cyclophosphamide, with or without fluorouracil, as adjuvant therapy. PATIENTS AND METHODS: Patients with resected breast cancer were treated if they were node-positive and estrogen receptor–negative, positive for overexpression of Her-2-neu, or had four or more involved nodes. Doxorubicin was given weekly to a total dose of 480 mg/m2. Cyclophosphamide 60 mg/m2 was given daily by mouth during the period of doxorubicin treatment. The first 30 patients received fluorouracil at 300 mg/m2/wk intravenously concurrently with doxorubicin administration. In the last 22, it was omitted because of symptomatic hand-foot syndrome in the majority of patients. Filgrastim (granulocyte colony-stimulating factor [G-CSF]) was administered during chemotherapy every day except the day of intravenous administration and continued until 1 week after the completion of the chemotherapy. RESULTS: Between October 20, 1992, and June 10, 1997, we enrolled 52 patients. The mean delivered dose-intensity for doxorubicin was 18.6 mg/m2/wk. Hospitalization was required in 6% of patients for reversible febrile neutropenia. There were no acute treatment-related deaths, but one patient subsequently died of acute leukemia with a characteristic translocation for anthracycline-related exposure. At 5 years, the event-free survival was 86% for all patients (95% confidence interval, 75% to 95%). CONCLUSION: Continuous dose-dense chemotherapy with G-CSF support produced encouraging results, which seem to be superior to those expected with “standard” doxorubicin and cyclophosphamide chemotherapy. It deserves a test in the form of a randomized trial where this approach to anthracycline-based treatment is compared with intermittent administration.
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Aljeboory, Ali A. H., and Nazhat M. Abdlkareem Al-Zubaidi. "Loranthus Europaeus is an Alternative Medicine in Treatment of Cyst and Mouth Inflammation Resulted from Chemotherapy of Breast Cancer." International Journal of Drug Delivery Technology 10, no. 01 (March 25, 2020): 183–86. http://dx.doi.org/10.25258/ijddt.10.1.32.
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The natural product continues to be important as a source of novel drugs because these drugs do not need a sophisticated instrument, cheap resources, less toxic, no resistance to them by bacteria compared with the synthetic drugs. However, the natural product will continue to be important in addition in three areas of discovery, they are a target for production by biotechnology, as source of new lead compounds of a novel chemical structure and as the active ingredients of useful treatments divided from traditional systems of folkloric medicine.1 The herb Loranthus Europaeus leaves, and fruits were used in Iraq traditional medicine for the treatment of inflammation, tumor, and antimicrobial infection.2 For these reasons, we tried to use the phytochemical and pharmacological studies to approach to their bioactive products as a new source for medicine. The extraction of an active constituent of Loranthus Europaeus (flavonoids terpenoids and alkaloids) by using chromatography method using a thimble of suxlet with different organic solvents. The ethyl acetate extract contain flavonoid, which contains quercitin and quercitrin. The active ingredient mixture of L.E. leaves extract have used as a mouth wash for female patient different age have breast cancer and under treatment with chemotherapy. We found that the bioactive martial extracted from L.E. used as mouth wash cause the cure of the inflammation of the mouth of those ladies. In addition that humans of different sexes complaining of cyst attached to one of their tooth treated with different types of antibiotic there was no response but when have given an antibiotic with bioactive agents of this L.E. there was complete cure of the cyst and there was no need for operation which give the possibility of presence of one or more of these (quercitin and quercitrin) active agents act as positive Nanocarrier of the antibiotic to the cyst directly and cure it.
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Macedo, Taysa B. C., Silvia T. Elias, Hianne M. Torres, Fernanda Paula Yamamoto-Silva, Dâmaris Silveira, Pérola O. Magalhães, Adriana Lofrano-Porto, Eliete N. S. Guerra, and Maria Alves G. Silva. "Cytotoxic Effect of Erythroxylum suberosum Combined with Radiotherapy in Head and Neck Cancer Cell Lines." Brazilian Dental Journal 27, no. 1 (February 2016): 108–12. http://dx.doi.org/10.1590/0103-6440201600014.
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Abstract The mouth and oropharynx cancer is the 6th most common type of cancer in the world. The treatment may involve surgery, chemotherapy and radiotherapy. More than 50% of drugs against cancer were isolated from natural sources, such as Catharanthus roseus and epipodophyllotoxin, isolated from Podophyllum. The biggest challenge is to maximize the control of the disease, while minimizing morbidity and toxicity to the surrounding normal tissues. The Erythroxylum suberosum is a common plant in the Brazilian Cerrado biome and is popularly known as "cabelo-de-negro". The objective of this study was to evaluate the cytotoxic activity of Erythroxylum suberosum plant extracts of the Brazilian Cerrado biome associated with radiotherapy in human cell lines of oral and hypopharynx carcinomas. Cells were treated with aqueous, ethanolic and hexanic extracts of Erythroxylum suberosum and irradiated at 4 Gy, 6 Gy and 8 Gy. Cytotoxicity was evaluated by MTT assay and the absorbance was measured at 570 nm in a Beckman Counter reader. Cisplatin, standard chemotherapy, was used as positive control. The use of Erythroxylum suberosum extracts showed a possible radiosensitizing effect in vitro for head and neck cancer. The cytotoxicity effect in the cell lines was not selective and it is very similar to the effect of standard chemotherapy. The aqueous extract of Erythroxylum suberosum, combined with radiotherapy was the most cytotoxic extract to oral and hypopharynx carcinomas.
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Fort, Pauline, Blandine Marsault, Antoine Hertzog, Emilie Dubost, Jean-Marc Tourani, and Isabelle Princet. "Use of complementary medicines by patients treated with chemotherapy: Survey in a French day care unit." Journal of Clinical Oncology 30, no. 15_suppl (May 20, 2012): e19555-e19555. http://dx.doi.org/10.1200/jco.2012.30.15_suppl.e19555.
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e19555 Background: Nowadays, communication about alternative medicines and biologic therapies is very intense. Anyone can find information, more or less scientific, on internet, television or magazines. Therefore, patients treated with chemotherapy may use many complementary medicines. The purpose of our study is to do a summary of the use of those alternative therapies by our patients in order to evaluate the potential risk of interference with their antitumor treatment. Methods: We carried out a prospective study among patients in the day care unit. During an interview, they were asking for any biological treatment or non-drug alternative medicine used concurrently with the chemotherapy. We found out: antitumor agent, complementary and alternative medicine used, aim of this use (prevention, antitumor action, wellbeing), means of access, person who advised them. Results: 100 patients were interviewed (average = 63 years old, half-and-half men and women). 38% used complementary and alternative medicines: 45% of whom used homeopathy, 39% food supplements, 37% herbal medicine, 29% non-drug alternative medicine (acupuncture, magnetic healer, meditation…). 29% of them associate more than 3 medicines. 61% of patients using herbal medicine, heard about it by word of mouth (friends and family); and 75% buy it by internet or by phone. Most of them are looking for wellbeing. 31% of patients using food supplements, looking for well being too, learnt it by word of mouth; 48% buy it in pharmacy, 40% on internet or by phone. 90% of patients using homeopathy were advised by their pharmacist or attending physician, mostly to prevent chemotherapy side effects. 95% buy it in pharmacy. Conclusions: A lot of patients are concerned by complementary and alternative medicines; and in too many case, they are advised by non-medical people. This survey shows the importance for oncologist to know exactly what kind of treatment their patients are using. Indeed, at least 16 of those patients associate medicines which reduce the antitumor agent’s activity. The survey will continue in other oncologic units.
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Karpenko, A. V., R. R. Sibgatullin, A. A. Boyko, M. G. Kostova, O. M. Nikolayeva, and E. M. Trunin. "Dynamics of quality of life of head and neck cancer patients after treatment. Clinical significance." Head and neck tumors (HNT) 8, no. 4 (January 13, 2019): 39–47. http://dx.doi.org/10.17650/2222-1468-2018-8-4-39-47.
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The study objective is to evaluate the quality of life as one of the main parameters that determines the effectiveness of treatment of patients with head and neck squamous cell carcinoma.Materials and methods. Thirty-three stage III—IV oral cancer patients aged between 39 and 70 years were asked to fill EORTC QLQ-C30 (European Organisation for Research and Treatment of Cancer quality of life questionnaire core 30-questions) and QLQ-H&N35 (head and neck cancer-specific module) before and 12—18 months after completion of the treatment that consisted of surgery followed by radiation with or without chemotherapy. Surgery included neck dissection with removal of the primary tumor via transoral (n = 5) or combined (n = 28) approach. Reconstruction was performed by primary closure (n = 5), with pedicled (n = 8) or free (n = 20) flaps.Results. According to EORTC QLQ-C30 questionnaire only positive shifts turned out to be statistically significant: general health, emotional function, pain, insomnia and diarrhea. Site-specific EORTC QLQ-H&N35 questionnaire revealed several positive (pain in the head and neck, feeling ill, use of painkillers and weight gain) and negative (public eating, problems with taste and smell, sticky saliva and dry mouth) changes. Applying algorithms for determining clinical significance changed the number and value of several scales and domains. Changes in general health, emotional function, pain, insomnia, pain in the head and neck, taste and smell disorders, mouth opening, sticky saliva, dry mouth, painkillers and weight gain were found to have some clinical relevance. Moreover, for one of them (mouth opening) statistical significance was not reached.Conclusions. Further research of clinical significance of changes and differences in scales and domains that determine and affect quality of life are needed. They will allow to understand more fully problems that every patient with oral cavity cancer tries to cope with.
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Grau, J. J., M. Caballero, E. Verger, and J. L. Blanch. "Actual proportion of patients (pts) receiving chemotherapy or cetuximab for head and neck squamous carcinoma (HNSC)." Journal of Clinical Oncology 27, no. 15_suppl (May 20, 2009): e17058-e17058. http://dx.doi.org/10.1200/jco.2009.27.15_suppl.e17058.
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e17058 Background: With the new indications of chemotherapy or cetuximab in HNSC, the rate of pts receiving these therapies nowadays is unclear. Methods: This retrospective study identified all consecutive pts with HNSC from January 1, 2006, to December 31, 2007, presented in a multidisciplinary team to decide further treatment in a single institution. ASCO guidelines for larynx preservation were followed to select surgery or chemoradiotherapy (ChRt). We classified the intention-to-treat as palliative, adjuvant or induction therapy. In the last case, always with concomitant radiotherapy (Rt) or prior to concomitant ChRt. Cetuximab was indicated with Rt as induction therapy for pts with problems to receive platin-based chemotherapy. Results: : A total of 350 pts were identified, 320 were male (91%), and 30 female (9%), with mean age 60.4 (range 41–90). Primary tumor was located in glottis (41%), supraglottis (19%), hypopharynx (11%), oropharynx (20%), or mouth (9%). Staging was I (27%), II (22%), III (16%), or IV (35%). Surgery alone was performed in 136 pts (39%) and chemotherapy or cetuximab in 214 other pts (61%). The intention-to-treat was palliative in 69 (32%), adjuvant in 51 (24%), or induction 94(44%) of the pts respectively. Rt plus cetuximab was administered to 31/97 (33%) and Rt plus chemotherapy in 63/97 (67%) pts as induction therapy. During this 2-year period, some pts received both induction/adjuvant and palliative chemotherapy. Conclusions: Chemotherapy or cetuximab is indicated as part of treatment in more than a half of pts with HNSC. Induction therapy is the most frequent indication. No significant financial relationships to disclose.
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Ohmae, Masatoshi, Itsuro Kato, Yusei Fujita, Hiroo Takaoka, Noritoshi Meshii, Ayako Takasu, and Mitsuhiro Nakazawa. "Outpatient intra-arterial chemotherapy without radiation therapy for stages II and III oral cancer: A new treatment to improve quality of life and reduce irradiation-related complications." Journal of Clinical Oncology 35, no. 15_suppl (May 20, 2017): e17567-e17567. http://dx.doi.org/10.1200/jco.2017.35.15_suppl.e17567.
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e17567 Background: We developed a superselective intra-arterial chemotherapy (iaCT) approach to oral cancer, in which an intra-arterial catheter is retrogradely inserted through the superficial temporal artery and/or occipital artery with concurrent radiation therapy (RT). This approach remarkably improves the curative effect, but it decreases patients’ quality of life (QOL) because of prolonged hospitalization, severe stomatitis, lifelong dry mouth, dysgeusia, and radiation osteonecrosis of the maxillo-mandibular bone. Methods: This study assessed our new outpatient iaCT (op-iaCT) approach involving a subcutaneous infusion reservoir without concurrent RT. We included 23 patients, 11 with stage II and 12 with stage III oral cancer, and they were treated with the op-iaCT approach without concurrent RT. Using this approach, the chemotherapeutic agent was intra-arterially administered at the Outpatient Chemotherapy Center of Rinku General Medical Center. Results: The response rate to this approach was 100%, and all patients had a complete response. Four patients with secondary regional lymph node metastasis underwent neck dissection. Twenty patients were disease-free without an irradiation-related complication, whereas 3 patients died of distant metastasis (2) or local recurrence (1). With the exception of ambulatory visits twice per week for 3 weeks, patients’ activities of daily living (ADLs) were mostly unaffected. Moreover, patients rarely complained of dry mouth or dysgeusia, and they were free from radiation osteonecrosis after cancer therapy. Additionally, they did not develop oral dysfunction related to radical operation. Conclusions: In this approach, the catheter is implanted subcutaneously; therefore, common catheter-related issues rarely occur, resulting in good maintenance of ADLs. Moreover, patients can avoid the side effects of RT. Consequently, patient’s QOL improves and medical expenses decrease. Thus, our new op-iaCT approach improves QOL and the curative effect in patients with oral cancer if their ambulatory and performance status is good.
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Soliman, Hanan Mohamed Mohamed. "The effect of cryotherapy on chemotherapy induced oral mucositis in Egyptian cancer patients: A randomized controlled trial." Journal of Nursing Education and Practice 9, no. 11 (August 26, 2019): 63. http://dx.doi.org/10.5430/jnep.v9n11p63.
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Background and objective: Oral Mucositis (OM) is a common adverse side-effect caused by cancer treatments (chemotherapy and/or radiotherapy). And can lead to mucosa toxicity. Patients with OM may experience extreme pain and may not be able to eat, drink and talk and, as a result, their quality of life is impaired. Treatment and prevention of OM in adult patients treated with chemotherapy are challenging issues for health care professionals. The aim of this study was to evaluate the effect of cryotherapy on incidence and severity of chemotherapy-induced OM and OM related pain in patients treated with combined chemotherapy (Fluorouracil and Leucovorin).Methods: This study is a randomized controlled trial with a random assignment to cryotherapy and control groups. The study was conducted on 40 cancer patients who underwent chemotherapy. The 20 patients in cryotherapy group were received instructions for sucking ice cubes in their mouth for five minutes before, during and shortly after chemotherapy. The 20 patients in control group received routine care. OM and pain severity were evaluated at 7th, 14th and 21st days of the study after chemotherapy using WHO Mucositis grading and-Numeric Pain Rating Scale.Results: In the majority of patients in cryotherapy group, oral Mucositis was not detected (Grade 0) at 7th, 14th and 21st days similarly incidence of grade 1 and 2 of OM in cryotherapy group significantly lowered when compared with control group where p < .001. During the study period, patients in the control group exhibit a significantly higher level of oral discomfort (p = .001).Conclusions: Oral cryotherapy due to its easy administration, tolerability and lack of adverse effects which makes it a very important method for decreasing the severity and incidence of OM and OM associated pain. The oncology nurses have a pivotal role in the application and success of cryotherapy.
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Friese, Christopher Ryan, Philip J. Stella, Beth Lavasseur, Paul T. Adams, Lauren Swafford, JoAnn Lewis, and Kari Michigan Mendelsohn-Victor. "Frequency and burden of patient-reported chemotherapy toxicities in community-based oncology practices." Journal of Clinical Oncology 32, no. 31_suppl (November 1, 2014): 178. http://dx.doi.org/10.1200/jco.2014.32.31_suppl.178.
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178 Background: Patient-reported outcomes measurement is recommended to improve care delivery. Toxicities are important to study given their impacts on treatment completion. We captured patient-reported toxicities in community-based oncology practices and identified toxicities associated with excess health care service use. Methods: We surveyed newly-diagnosed patients who completed their first chemotherapy cycle at 5 community practices. Exclusion criteria were prior cancer history, non-English speakers, psychiatric diagnosis, and clinical trial participation. At the second cycle return visit, patients completed a questionnaire that measured the severity of nausea, vomiting, diarrhea, constipation, mouth sores, intravenous catheter problem, pain, fever/chills, extremity edema, and dyspnea. These were rated on a 5-point scale (1= did not experience to 5 = very severe). Patients also reported unscheduled oncologist visits, emergency department visits, or inpatient hospitalization. Results: Of 117 eligible patients, 106 (91%) participated. Most patients (98%) were white, 25.5% were male, and the mean(SD) age was 60 (11) years. The most frequent diagnoses were breast (43%), lung (21%), colorectal cancer (13%), and non-Hodgkin lymphoma (13%). Between cycle 1 and 2, frequent severe or very severe toxicities were nausea (30%), pain (18%), diarrhea (9%), and mouth sores (9%). 15% of patients had an unscheduled oncologist visit, 18% had an emergency department visit, and 9% of patients were admitted. Nausea (11.3%) and diarrhea (6.6%) were frequent reasons for unscheduled oncology visits; nausea and pain (both 5%) for emergency department visits, and; pain and dyspnea (both 2%) for hospitalization. Conclusions: Patient-reported toxicity monitoring is feasible and informative in community-based oncology practices. Despite widespread antiemetic use, nausea is a pervasive problem for newly-treated patients and drives excess service use. Pain assessment and management strategies are needed to reduce emergency department visits and hospitalizations.
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LeBlanc, Thomas William, Steven Wolf, Debra M. Davis, Greg Samsa, Susan C. Locke, Karen E. Steinhauser, Peter A. Ubel, James A. Tulsky, and Amy Pickar Abernethy. "Symptom burden, quality of life, and distress in acute myeloid leukemia patients receiving induction chemotherapy: A prospective electronic patient-reported outcomes study." Journal of Clinical Oncology 32, no. 31_suppl (November 1, 2014): 167. http://dx.doi.org/10.1200/jco.2014.32.31_suppl.167.
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167 Background: Induction chemotherapy for acute myeloid leukemia (AML) is more intensive than many solid tumor treatments, and may be associated with a different symptom burden. Little is known about the most prevalent symptoms during AML induction, nor how they change over time. Methods: We enrolled AML inpatients at initiation of induction chemotherapy, and assessed their symptoms, quality of life (QoL), and distress weekly during their month-long hospitalization for treatment, using 3 validated instruments: Patient Care Monitor v2.0 (PCM); Functional Assessment of Cancer Therapy–Leukemia (FACT-Leu); and NCCN distress thermometer (DT). Here we report results from the first 16 enrolled patients, using standard descriptive statistics. Results: Mean age of study participants was 59.6 (SD 12.2), and most were newly diagnosed with AML (SD 87.5%, n=14). Patients were mostly high-risk for recurrence, with 50% (8) being >60 years old and 71% (10) having high-risk cytogenetics. Fatigue was the most prevalent symptom, with an average of 59% of patients reporting moderate to severe fatigue at each assessment. The other most prevalent moderate/severe non-functional symptoms were dysgeusia (50%), dry mouth (42%), diarrhea (41%), decreased appetite (37.5%), insomnia (37.5%), daytime sleepiness (36%), nausea (36%), hair loss (36%), and mouth sores (34%). Median QoL by FACT-Leu total score decreased substantially between weeks 1 and 2 (118.5 to 104.5); the most substantial decrements were in subscales for personal well-being and functional well-being (20.5 to 14.5, and 13.5 to 8.5, respectively). QoL did not return to baseline by week 4. Median DT score at baseline was 6.5, with a trend towards weekly improvements in distress (DT = 3 at week 4). Depressive symptoms like hopelessness and sadness were reported by an average of 25% and 31.3% of patients, respectively. Conclusions: AML patients receiving induction chemotherapy have significant symptom burden, impaired QoL, and psychological distress. The prevalence of these issues suggests sizeable unmet palliative care and psychosocial needs in AML patients receiving induction chemotherapy.
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Panattoni, Laura Elizabeth, Salene M. W. Jones, Kaylin J. Bolt, Karma L. Kreizenbeck, Annika Ittes, and Scott David Ramsey. "Patient and provider perceptions of emergency room visits during chemotherapy." Journal of Clinical Oncology 37, no. 27_suppl (September 20, 2019): 183. http://dx.doi.org/10.1200/jco.2019.37.27_suppl.183.
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183 Background: Emergency room (ER) visits during chemotherapy are costly. To identify potential causes of ER visits, we interviewed oncology patients and providers about symptoms and other factors related to ER visits. Methods: People with cancer (n = 19) and oncology physicians and nurses (n = 11) were interviewed using a semi-structured protocol. Interviews were transcribed. The study team developed a codebook and interviews were coded deductively. Four of the interviews were double coded. Results: Patients reported communicating with their physicians mostly by telephone. Patients reported a variety of distressing symptoms from chemotherapy including infection, mouth sores, distress, fatigue, neuropathy, gastrointestinal (GI) effects. Pain, fever, neuropathy, and dizziness were symptoms that motivated ER visits. Patients reported that contact with their care team and having a specific plan for symptoms helped prevent ER visits. Patients also reported that going through chemotherapy the first time was harder because they did not know what to expect and the patient education can be overwhelming. Providers did not always have formal protocols for proactively contacting patients but those that did contacted patients early in treatment. Providers reported GI symptoms, pain, shortness of breath, dizziness, and infection as causes of ER visits. They reported difficulties assessing symptoms due to reporting inaccuracies and reticence to share details. Providers cited financial insecurity, remote living, and lack of social support as factors increasing risk of ER visits. Providers reported some patients would not call frequently enough while a smaller subset called more frequently than providers perceived as needed. Conclusions: Results suggest contact with the care team is crucial for preventing ER visits during chemotherapy. Symptoms causing ER visits were consistent with previous literature
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Navari, R. M., L. H. Einhorn, P. J. Loehrer, S. D. Passik, J. Vinson, J. McClean, N. Chowhan, N. Hanna, C. Calley, and M. Yu. "A phase II trial of olanzapine and palonosetron for the prevention of chemotherapy induced nausea and vomiting (CINV)." Journal of Clinical Oncology 24, no. 18_suppl (June 20, 2006): 8608. http://dx.doi.org/10.1200/jco.2006.24.18_suppl.8608.
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8608 Background: Olanzapine has been shown to be a safe and effective agent for the prevention of CINV in chemotherapy naïve cancer patients. Palonosetron has been approved for the prevention of acute CINV and for the prevention of delayed CINV in patients receiving moderately emetogenic chemotherapy (MEC). Methods: A phase II trial was performed for the prevention of CINV in chemotherapy naïve patients using the combination of olanzapine and palonosetron. The regimen was 10 mg of oral olanzapine, 0.25 mg of intravenous palonosetron, and dexamethasone (20 mg for highly emetogenic and 8 mg for moderately emetogenic chemotherapy) on the day of chemotherapy, day 1, and 10 mg/day of oral olanzapine alone on days 2–4 after chemotherapy. Forty patients (median age 60 yrs, range 38–84; 22 females; ECOG PS 0,1) consented to the protocol and all were evaluable. Results: The percentage of patients with a complete response (CR) (no emesis, no rescue) was 100% for the acute period (24 h post chemotherapy), 75% for the delayed period (days 2–5 post chemotherapy), and 75% for the overall period (0–120 h) for eight patients receiving highly emetogenic chemotherapy (HEC) (cisplatin > 70 mg/m2). CR was 97% for the acute period, 75% for the delayed period, and 72% for the overall period in 32 patients receiving MEC (doxorubicin, >50mg/m2). In the patients receiving HEC, the percentage of patients without nausea (0, scale 0–10, M. D. Anderson Symptom Inventory) was 100% in the acute period, 50% in the delayed period, and 50% in the overall period. In patients receiving MEC, the percentage without nausea was 100% in the acute period, 78% in the delayed period, and 78% in the overall period. There were no Grade 3 or 4 toxicities and no significant pain, fatigue, disturbed sleep, memory changes, dyspnea, lack of appetite, drowsiness, dry mouth, mood changes or restlessness experienced by the patients. CR and control of nausea in subsequent cycles of chemotherapy (35 patients, cycle 2; 31 patients cycle 3; 23 patients, cycle 4) were equal to or greater than cycle one. Conclusions: The combination of olanzapine and palonosetron with dexamethasone given only on the day of chemotherapy was safe and highly effective in controlling acute and delayed CINV in patients receiving HEC and MEC. No significant financial relationships to disclose.
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Pendharkar, D., S. Gupta, M. K. Pal, S. Hakim, and T. Rashid. "Feasibility of combining humanized anti-epidermal growth factor receptor monoclonal antibody h-R3 (nimotuzumab) with chemotherapy-A study of toxicity profile and tolerance." Journal of Clinical Oncology 25, no. 18_suppl (June 20, 2007): 14151. http://dx.doi.org/10.1200/jco.2007.25.18_suppl.14151.
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14151 Background. Anti-EGFR antibodies have been approved in combination with radiotherapy for the treatment of head and neck squamous cell carcinoma(SCCHN) and being tried in glioblastoma multiforme(GBM). The overall toxicity profile is tolerable. There is no data available on Humanized Anti EGFR antibody in combination with chemotherapeutic agents. Nimotuzumab, the humanized MAb derived from ior EGFR/R3, is a genetically engineered IgG1, with high affinity and specificity to EGFR. This study was undertaken to record the immediate and early toxicity of combining Nimotuzumab with various chemotherapeutic agents. Methods. Patients with SCCHN and GBM, scheduled to receive chemotherapy alone were additionally given 400mg of Nimotuzumab, every three weeks. Two patients with GBM received weekly Nimotuzumab 200 mg along with radiation and chemotherapy. Overall 19 events have been analyzed. The chemoschedules used in combination with Nimotuzumab included-Docetaxel, Carboplatin and Capecitabine in patients with SCCHN and Temozolamide/ Procarbazine in GBM. Antibody infusion was always preceded by antihistaminics and dexamethasone. Results.The combination of Nimotuzumab with chemotherapy was well tolerated. There were no acute infusion related events. No febrile, allergic or anaphylactic episodes were seen. Cutaneous rash classical of other EGFR blockers was not recorded. Two episodes of grade 3 diarrhea, and four events of asthenia were seen. Dryness of the mouth was a complaint in SCCHN patients. None of the patients showed neurological or cardiovascular adverse events. Hematological and biochemical derangements were not observed. Conclusion. Nimotuzumab can safely be combined with various chemotherapeutic agents .There is no unacceptable toxicity associated with combination of chemotherapy and humanized anti-EGFR monoclonal antibody. New schedules combining Nimotuzumab and chemotherapy can be safely explored. No significant financial relationships to disclose.
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Dodd, M. J., M. Cho, C. Miaskowski, and J. Quivey. "A longitudinal evaluation of oral mucositis in patients receiving radiation therapy (IMRT) with/without chemotherapy (CTX)." Journal of Clinical Oncology 27, no. 15_suppl (May 20, 2009): e20572-e20572. http://dx.doi.org/10.1200/jco.2009.27.15_suppl.e20572.
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e20572 Background: Oral mucositis is a major side effect of RT ± CTX to the head and neck. A variety of instruments and techniques have been used to quantify oral cavity changes during treatment. Few studies have reported on the evaluation of oral mucositis using both subjective and objective methods. A secondary aim in our study testing an innovative mouthwash is to increase our understanding of using subjective and objective methods for measuring oral mucositis, functional status, and weight changes over time. Methods: Patients reported functional status, pain and investigators measured oral mucositis and weight at four times (beginning of RT [T1], onset of mucositis [T2], end of RT [T3], and healing of mucositis [T4]) over a 10 - 15 week period, using the Karnofsky Performance Status [KPS]) and the Oral Mucositis Assessment Scale (OMAS). The OMAS measures researcher-evaluated ulceration/pseudomembrane formation and erythema in specific sites in the mouth, and self-report by patients, rating severity of mouth pain, ability to swallow and chew. Results: Of 51 head and neck cancer patients enrolled, 3 never developed mucositis. Mean days to onset of mucositis was 15.58 (SD 6.85), and mean days to healing of mucositis was 77.86 (SD 40.1). Mucositis pain scores (possible range 0–45) were moderate at T2 (x=6.25, SD 3.5) and T3 (x=12, SD 5.0). Subjective pain, chewing, and swallowing scores were positively correlated with each other (r= .31 - .73, p<.05) and objective oral mucositis scores were positively correlated with each other (r= .49 - .77, p<.01), however, no significant correlations were obtained between the subjective and objective scores. In both the RT-only group as well as the RT+CTX group, weight significantly decreased from T1 to T4, and KPS significantly decreased from T1 to T3. RT+CTX patients showed lower KPS and greater weight loss from T1 to T4 (X=10lbs) compared to the RT-only group (X=3 lbs), but neither was significantly different. Conclusions: During RT+CTX, patients need more supportive care to maintain functional status and avoid weight loss. Lack of correlations between the subjective and objective scores is interesting in that they are measuring something quite different, which may provide some insight into underlying mechanisms. No significant financial relationships to disclose.
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Johnson, N. "Quantifying the Immense Burden of OPMDS and of Oral Cancer in South Asia: Time for Action." Journal of Global Oncology 4, Supplement 2 (October 1, 2018): 125s. http://dx.doi.org/10.1200/jgo.18.20600.
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Background: Cancer of head and neck is sixth most common malignancy worldwide https://www.ncbi.nlm.nih.gov/pubmed/27245686 . ∼90% are squamous cell carcinomas [HNSCC]. Of H&N sites, mouth is most common [∼300,373 cases pa, cf oropharynx ∼142,387; larynx ∼156,877; nasopharynx 86,691]. Across south Asia, cancer of lip & mouth [oral cancer: OSCC] is a serious public health problem. In many, it is the most common cancer among men, 5th/6th in women, second overall. Five year survival rates are < 50%. Treatment is devastating. It is difficult to get authorities and public to recognize the problem: this is not a “glamorous” cancer. Yet we know the major causes so most disease is preventable. In south Asia, the major causes are tobacco - mostly chewed, areca [erroneously called betel] nut, mostly as component of betel quid, and heavy alcohol use in a background of diets lacking adequate antioxidant vitamins/minerals. To this is added the global epidemic of human papillomavirus [HPV]-driven nonkeratinising squamous epithelial head/neck cancer, particularly in lymphoid tissues of Waldyer's ring. Though data vary by country, high-risk [hr]HPVs are likely associated with up to 30% of OSCC too. We need detailed local information, especially as hrHPV-driven SCC respond well to radio/chemotherapy. Next-generation molecular methods are now examining roles for fungi and bacterial consortia. Across Asia, most OSCC arise from long-standing changes in oral mucosa: oral potentially malignant disorders [OPMD]. Leukoplakia is commonest, though with lowest risk. Risk is greater in red or mixed red/white lesions. Oral submucous fibrosis is prevalent and devastating. It has a high rate of malignant transformation and causes immense suffering: burning mouth, taste disturbances and severe sclerosis of soft tissues resulting in restricted mouth opening. The major etiology is areca nut. There is genetic and inherited propensity: very young children encouraged to chew areca can be seriously affected. There are no truly successful treatments, be it surgery to relieve trismus, physiotherapy to improve mouth opening and dietary supplements with numerous antioxidants, most commonly curcumin. Strategy: Primary prevention is possible. Improve diet; no tobacco; no areca nut [we need a WHO Framework Convention on areca]: to nip in the bud a serious epidemic of HPV-related cancers, sexual hygiene and widespread vaccination of girls - in my opinion also of boys. Public education is key. Legal controls on tobacco, areca & alcohol are needed - a tremendous challenge especially for areca, given the ancient cultural importance of this masticatory in myriad forms. It is time for effective action. Outcomes: In India and Sri Lanka we have made great progress with public awareness and with regulations on advertising and sale of smokeless tobacco and some areca products. Southeast Asia lags behind. HPV vaccination requires greater uptake across the region. What was learned: Both top-down and bottom-up approaches are needed.
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Hussain, Syed Md Akram. "Comprehensive update on cancer scenario of Bangladesh." South Asian Journal of Cancer 02, no. 04 (October 2013): 279–84. http://dx.doi.org/10.4103/2278-330x.119901.
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AbstractBangladesh, at 142 million people, is the ninth most populous country in the world. There are 13 to 15 lakh cancer patients in Bangladesh, with about two lakh patients newly diagnosed with cancer each year. As an overview, lung cancer and mouth-oropharynx cancer rank as the top two prevalent cancers in males. Other types of cancers are esophagus cancer and stomach cancer. In women, cancer cervix uteri and breast cancer are most prevalent. Other cancer types, which affect women, are mouth and oropharynx cancer, lung cancer, and esophagus cancer. There are around 150 qualified clinical oncologists and 16 pediatric oncologists working in the different parts of the country. Regular cancer treatment is available in 19 hospitals and 465 hospital beds are attached as indoor or day care facilities for chemotherapy in the oncology/radiotherapy departments. There are about 15 linear accelerators, 12 Co-60 teletherapy and 12 brachytherapy units currently available. Approximately, 56 cancer chemotherapeutic agents are obtainable in Bangladesh. Research facilities are available at tertiary care centers and a few multi country collaborative research activities are ongoing. Bangladesh has a unique National Cancer Control Strategy and Plan of Action 2009-2015 formulated with the assistance of WHO with an objective to develop and implement continuum of cancer care through a comprehensive cancer control programe. Preventive measures taken to reduce the incidence of cancer include reduced tobacco smoking, change of dietary habit and reduced food adulteration, ensuring reproductive hygiene, increased physical activity, and reduced occupational hazard. Awareness buildup and media campaign are going on by organizing the general people, opinion leaders of the society, and boy and girl scout. Training of general physicians on cancer warning signs and setup of early cancer detection centers at each medical college and district levels are ongoing. Beside these, some other major cancer programs have taken place for early detection of breast, cervical and oral cancer by Bangladesh Government and NGOs such as ICDDR'B, BRAC, Ahsania Mission Cancer Hospital, BSMMU, Bangladesh Cancer Society, Ashic Foundation, Amader Gram, AK Khan Healthcare Trust, CANSUP, Oncology club etc. Piloting of cervical cancer vaccination has recently been completed. Improving the cancer scenario overnight is not an easy task but policy makers may become interested and push this agenda forward, if the huge health impact and economic loss caused by cancer become evident to them. Besides, Bangladesh has accepted reduction of cancer morbidity and mortality targets set by United Nations and World Health Organization as a part of global non-communicable disease prevention agreement.
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Rivkin, S. E., S. Green, B. Metch, A. B. Cruz, M. D. Abeloff, W. R. Jewell, J. J. Costanzi, W. B. Farrar, J. P. Minton, and C. K. Osborne. "Adjuvant CMFVP versus tamoxifen versus concurrent CMFVP and tamoxifen for postmenopausal, node-positive, and estrogen receptor-positive breast cancer patients: a Southwest Oncology Group study." Journal of Clinical Oncology 12, no. 10 (October 1994): 2078–85. http://dx.doi.org/10.1200/jco.1994.12.10.2078.
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PURPOSE To compare chemohormonal therapy, chemotherapy alone, and hormonal therapy alone in postmenopausal patients with estrogen receptor (ER)-positive operable breast cancer and positive axillary nodes with respect to survival and disease-free survival (DFS). PATIENTS AND METHODS Eight hundred ninety-two postmenopausal women with ER-positive, node-positive breast cancer were enrolled by the Southwest Oncology Group (SWOG) from July 1979 to March 1989 and 74 by the Eastern Cooperative Oncology Group (ECOG) between June 1987 and March 1989. Patients were stratified according to number of involved nodes and type of primary surgery and randomized to receive the following: (1) tamoxifen 10 mg twice daily by mouth for 1 year; (2) cyclophosphamide 60 mg/m2/d by mouth for 1 year, methotrexate 15 mg/m2 intravenously (IV) weekly for 1 year, fluorouracil (5-FU) 400 mg/m2 IV weekly for 1 year, vincristine .625 mg/m2 IV weekly for the first 10 weeks, and prednisone during weeks 1 to 10 with doses decreasing from 30 mg/m2 to 2.5 mg/m2 (CMFVP); or (3) the combination of tamoxifen and CMFVP. RESULTS The median follow-up duration is 6.5 years, with a maximum of 12.8 years. Treatment arms are not significantly different with respect to either survival or DFS (log-rank, 2 df, P = .82 and .23, respectively). The 5-year survival rate is 77% for the tamoxifen arm, 78% for CMFVP, and 75% for the combination. No significant differences were observed in node or receptor level subsets. Severe or worse toxicity was experienced by 56% of patients on CMFVP and 61% on CMFVP plus tamoxifen, compared with 5% on tamoxifen alone. CONCLUSION CMFVP chemotherapy, either alone or in combination with tamoxifen, has not been shown to be superior to tamoxifen alone in the treatment of postmenopausal women with node-positive, ER-positive, operable breast cancer.
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Srinivas, Mangala, Ravichandra Volabailu, Jayarama Shetty K., and Sangeeta Nath Sharma. "A study on management of oral cancer in a tertiary care hospital." International Journal of Basic & Clinical Pharmacology 7, no. 2 (January 23, 2018): 278. http://dx.doi.org/10.18203/2319-2003.ijbcp20180098.
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Background: Oral cancers form nearly 30% of the cancers. The most effective way of combating oral cancer is by early diagnosis followed by concurrent chemo-radiotherapy which is the most popular approach in current practice. The adverse effects seen in oral cancer patient’s due to their treatment are nausea & vomiting, mucositis, constipation, diarrhoea, fatigue & radiation dermatitis. Polypharmacy is due to variety of treatment options in oral cancer patients, which needs to be addressed.Methods: Over a period of 18 months, the in-patient records of 79 patients with oral cancers, admitted to oncology ward of Justice K. S. Hegde Charitable Hospital, Mangalore, were scrutinized and the data collected in a specially designed proforma. Descriptive analysis of the data was done.Results: Required data was collected from 79 patients, out of which 55.7% of the patients underwent surgery and later received chemotherapy and radiotherapy. Most commonly seen adverse effects due to treatment were weight loss (75.9%), reduced appetite (67.1%), fatigue (75.9%), pain (79.7%) and skin discoloration (50.6%), etc. Various classes of adjuvant drugs were used for complications caused due to the treatment of oral cancers. Drugs like topical applicant /mouth washes constituted the bulk of the prescriptions (22%) followed by nutritional supplements (15.34%), NSAID/opioids (12.76%) hematinic (12.59 %) and other groups of drugs were also used.Conclusions: Present study helped us to plan evidence based strategies to reduce or prevent post treatment complications. Most of the adverse effects were treated accordingly to keep the patient comfortable.
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del Giglio, Adriana Braz, Tatiana Goberstein Lerner, Henrique Soares Paiva, Renata Guise Soares Azevedo, Ricardo tuma Guariento, Cecilia Goldman, Bruno Carelli, et al. "Purified dry extract of Paullinia cupana (guaraná) (PC-18) for chemotherapy-related fatigue in patients with solid tumors: An early discontinuation study." Journal of Clinical Oncology 31, no. 15_suppl (May 20, 2013): e20680-e20680. http://dx.doi.org/10.1200/jco.2013.31.15_suppl.e20680.
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e20680 Background: Paullinia cupana (guaraná) is an Amazonian plant that has been previously shown to be effective in treating chemotherapy-related fatigue (CRF) in patients with breast cancer. We aimed to evaluate the efficacy of a purified dry extract of P. cupana (PC-18) in patients with various solid tumors treated with chemotherapy. Methods: We included 40 patients with solid tumors who showed increases in their Brief Fatigue Inventory (BFI) questionnaire scores after one week of systemic chemotherapy. PC-18 was administered at 37.5 mg by mouth two times per day (PO bid), starting after one week of chemotherapy, for three weeks (induction phase). Patients who had an improvement in or stabilization of their BFI scores were randomized to receive either PC-18 at the same dose or placebo for the following three weeks (maintenance phase). Results: After PC-18 treatment, the BFI fatigue scores improved or stabilized in 36 out of the 40 patients (mean BFI score difference = 2.503; 95% CI: 1.716 – 3.375, P = 0.0002). Three weeks after randomization (16 patients on PC-18 and 17 on placebo), we observed no significant differences in the BFI, FACIT, HADS, and PSQI scores between patients randomized to PC-18 versus placebo. Conclusions: We conclude that the PC-18 extract is effective for the treatment of CRF in patients with a variety of solid tumors. A conditioning effect, which was observed in patients with early positive effects of PC-18 on CRF, may explain the better than expected fatigue scores of the placebo-treated patients.
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Hoppe, C., S. Kutschan, J. Dörfler, J. Büntzel, J. Büntzel, and Jutta Huebner. "Zinc as a complementary treatment for cancer patients: a systematic review." Clinical and Experimental Medicine 21, no. 2 (January 26, 2021): 297–313. http://dx.doi.org/10.1007/s10238-020-00677-6.
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AbstractZinc is a trace element that plays an important role in the immune system and cell growth. The role of zinc in cancer treatment has been discussed for some time, however without reaching an evidenced-based consensus. Therefore, we aim to critically examine and review existing evidence on the role of zinc during cancer treatment. In January 2019, a systematic search was conducted searching five electronic databases (Embase, Cochrane, PsychINFO, CINAHL and PubMed) to find studies concerning the use, effectiveness and potential harm of zinc therapy on cancer patients. Out of initial 5244 search results, 19 publications concerning 23 studies with 1230 patients were included in this systematic review. The patients treated with zinc were mainly diagnosed with head and neck cancer and underwent chemo-, radio- or concurrent radio-chemotherapy. Interventions included the intake of different amounts of zinc supplements and oral zinc rinses. Outcomes (primary endpoints) investigated were mucositis, xerostomia, dysgeusia, pain, weight, dermatitis and oral intake of nutrients. Secondary endpoints were survival data, quality of life assessments and aspects of fatigue, immune responses and toxicities of zinc. The studies were of moderate quality reporting heterogeneous results. Studies have shown a positive impact on the mucositis after radiotherapy. No protection was seen against mucositis after chemotherapy. There was a trend to reduced loss of taste, less dry mouth and oral pain after zinc substitution. No impact was seen on weight, QoL measurements, fatigue, and survival. The risk of side effects from zinc appears to be relatively small. Zinc could be useful in the prevention of oral toxicities during irradiation. It does not help in chemotherapy-induced side effects.
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Bolton, Laura. "Managing Oral Mucositis in Patients With Cancer." Wounds : a compendium of clinical research and practice 33, no. 5 (May 10, 2021): 136–38. http://dx.doi.org/10.25270/wnds/2021.136138.
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Patients with oral mucositis (OM) have inflamed epithelial lesions of the mouth that progress to form painful ulcerations with submucosal hemorrhaging and infection. Oral mucositis makes it painful to eat, drink, and speak, resulting in distress, weight loss, and declining health. These symptoms occur in up to 40% of patients within 5 to 10 days after beginning chemotherapy (CT), and in nearly all patients within 1 to 2 weeks of starting radiotherapy (RT) for head and neck cancer. Oral mucositis can be severe enough to interrupt treatment and reduce survival rates. In 2014, the Mucositis Guidelines Leadership Group of the Multinational Association of Supportive Care in Cancer and International Society of Oral Oncology released OM treatment guidelines aiming to provide nutritional support, while reducing pain, inflammation, hemorrhaging, and oral microbial contamination. This installment of Evidence Corner explores 2 recent systematic reviews of randomized controlled trial (RCT) evidence informing clinical decisions in ways that may change thoughts about effective topical OM treatment.
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Rangineni, Srikrishnadevarayulu, Debarshi Lahiri, Biplab Misra, Tapas Maji, Sanjoy Roy, Dilip Kumar Ray, Saptarshi Banerjee, Subhadip Das, and Ashwin Mohandas Pallath. "Hypofractionated intensity-modulated radiation therapy with concurrent cisplatin in locally advanced oropharyngeal cancer: feasibility experience from a Government cancer centre of Eastern India in a resource-constrained setting." Journal of Radiotherapy in Practice 19, no. 1 (May 29, 2019): 59–64. http://dx.doi.org/10.1017/s1460396919000323.
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AbstractPurpose:Radiation therapy (RT), in combination with chemotherapy, is the mainstay in the treatment for locally advanced oropharyngeal cancer. We analysed the tumour response and the toxicity profiles in patients having locally advanced oropharyngeal cancers receiving hypofractionated intensity-modulated radiation therapy (IMRT) and concurrent chemotherapy with Cisplatin investigating the feasibility and radiobiological efficacy of the regimen, along with its use as a resource-sparing alternative for a high-volume centre.Material and Methods:The records of 41 eligible patients with locally advanced squamous cell carcinoma of oropharynx, registered from September 2015 to April 2017, treated with hypofractionated IMRT with concurrent Cisplatin, were analysed from the hospital database. Patients received concurrent chemo-radiation with 2 cycles of 3-weekly cisplatin on day 1 and day 22 along with hypofractionated IMRT, 55 Gy delivered in 20 fractions over 4 weeks. Patients were observed for any radiation reaction or chemotherapy toxicity at least once a week during the course of radiation therapy.Results:Twenty-nine patients (70·7%) achieved complete response and remaining 12 showed partial response. Acute grade 3 toxicity was observed mostly in the form of oral mucositis and radiation dermatitis. Both grade 3 oral mucositis and radiation dermatitis were seen in 15 patients (36·6%) and 7 patients (17%), respectively. The most common late toxicities were dysphagia and dry mouth. Twenty-five patients (61%) completed the overall treatment within 4 weeks’ duration.Conclusion:This hypofractionated regimen is feasible and was associated with tolerable acute and late morbidity and satisfactory locoregional response. Larger prospective, multi- institutional studies examining similar schedules may be undertaken to establish this as a standard practice, particularly for a high-volume centre.
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Galitis, Evangelos, Vyron Droukas, Michail Tzakis, Vassileios Psarras, Dimitra Galiti, Eythymios Kyrodimos, Miltiadis Trichas, et al. "Trismus and reduced quality of life in patients with oral squamous cell carcinoma, who received post-operative radiotherapy alone or combined with chemotherapy." Forum of Clinical Oncology 8, no. 1 (June 30, 2017): 29–36. http://dx.doi.org/10.1515/fco-2015-0023.
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Abstract Background Patients, who receive radiotherapy (RT) for head and neck cancer, develop chronic functional abnormalities and survive with reduced quality of life. Purpose We aimed to study patients with oral cancer, who received post-operative radiotherapy or chemoradiotherapy. Patients Ten patients (mean age 63.8 years) were included. Methods Oral mucositis, pain and xerostomia, maximum mouth opening (MMO) and functional abnormalities before and after RT were recorded. The 35 mm MMO or less was accepted as trismus. Patients completed the EORTC QLQ C-30 and Head/Neck35 questionnaires. Results Mean RT dose was 64.3 Gray. Six patients received chemoradiotherapy. Severe mucositis, pain and xerostomia were recorded in 6 and 5 patients respectively. MMO was reduced in all patients. The mean MMO (34 mm) reached the level of trismus. The total number of symptoms increased from 3.1 to 6.3 in C-30 and from 3.1 to 8.8 per patient in the H/N35. Severe fatigue, pain, limitations at work, weakness, sad feelings, family problems, sleeping problems, anorexia, financial difficulties, tense/irritable, constipation, nausea, vomiting and depression were most often reported with C-30. Most patients reported low to moderate quality of life. Severe oral, jaw and neck pain, swallowing problems, taste alterations, sticky saliva, dry mouth, coarseness, dental problems, feeling sick and reduced interest in life/sex were the most common symptoms reported with N/H35. Conclusions The observed trismus, 2- to 3-fold increase of symptoms and poorer quality of life highlighted the need for support of oral cancer patients, who receive postoperative radiotherapy or chemoradiotherapy.
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Bown, Stephen G. "Photodynamic therapy for photochemists." Philosophical Transactions of the Royal Society A: Mathematical, Physical and Engineering Sciences 371, no. 1995 (July 28, 2013): 20120371. http://dx.doi.org/10.1098/rsta.2012.0371.
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Photodynamic therapy (PDT) is an evolving technique for localized control of diseased tissue with light after prior administration of a photosensitizing agent and in the presence of oxygen. The biological effect is quite different from surgery, radiotherapy and chemotherapy. With no temperature change during treatment, connective tissues like collagen are largely unaffected, so maintaining the mechanical integrity of hollow organs. PDT is of particular value for pre-cancer and early cancers of the skin (not melanomas) and mouth as the cosmetic and functional results are so good. Another key indication is for small areas of cancer that are unsuitable for or have persisted or recurred after conventional management. It can be applied in areas already exposed to the maximum safe dose of radiotherapy. Outside cancer, in ophthalmology, it is established for age-related macular degeneration, and has considerable potential in arterial disease for preventing restenosis after balloon angioplasty and in the treatment of infectious diseases, where the responsible organisms are accessible to both the photosensitizer and light. New developments on the horizon include techniques for increasing the selectivity for cancers, such as coupling photosensitizers to antibodies, and for stimulating immunological responses, but many further pre-clinical and clinical studies are needed to establish PDT's role in routine clinical practice.
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Zheng, Wang Fang, and Chuner Jiang. "Treatment outcomes of 257 patients with locally advanced nasopharyngeal carcinoma treated with nimotuzumab plus intensity-modulated radiotherapy with or without chemotherapy: A single institution experience." Journal of Clinical Oncology 35, no. 15_suppl (May 20, 2017): 6079. http://dx.doi.org/10.1200/jco.2017.35.15_suppl.6079.
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6079 Background: To report the long-term outcome and toxicitie of locally advanced nasopharyngeal carcinoma (NPC) treated with nimotuzumab plus intensity- modulated radiotherapy (IMRT) with or without chemotherapy. Methods: From October 2009 to March 2014, 257 newly histology-proven, non-metastatic NPC patients were retrospectively enrolled. They are aged 10-76 years. The distribution of disease was stage III in 150 (58.4%), stage IV A in 88 (34.2%), and stage IV B in 19 (7.4%). All the patients received the treatment of nimotuzumab plus IMRT, and 239 cases were used for cisplatin-based chemotherapy. Acute and late radiation-related toxicities were graded according to the Acute and Late Radiation Morbidity Scoring Criteria of Radiation Therapy Oncology Group. The accumulated survival was calculated according to the Kaplan-Meier method. Log-rank test was used to compare the survival difference. Multivariate analysis was performed using Cox’s proportional hazard model. Results: All patients had completed the combined treatment. With a median follow-up of 48 months (range, 13–94 months), the estimated 3-year and 5-year overall survival rates were 92.6% and 86.2%, respectively. Univariate analysis showed that age, T stage, clinical stage and neoadjvant chemotherapy were related with OS. Multivariate analysis indicated that age and clinical stage were independent prognosticators. The median cycle for nimotuzumab addition was 12 weeks. The incidence of grade 3–4 acute mucositis and leukocytopenia were 10.9% and 9.3%, respectively, with no cases of skin rash and infusion reaction. Xerostomia was the most common late complication, and the degree of dry mouth in most survivors was mild-to-moderate at the last follow-up time. Conclusions: Nimotuzumab plus IMRT with or without chemotherapy showed promising outcomes in terms of loco-regional control and survival, without increasing the incidence of radiation-related toxicities for patients.
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Zhang, Lingyun, Xiujuan Qu, Yuee Teng, Jing Shi, Ping Yu, Tao Sun, Jingyan Wang, et al. "Efficacy of Thalidomide in Preventing Delayed Nausea and Vomiting Induced by Highly Emetogenic Chemotherapy: A Randomized, Multicenter, Double-Blind, Placebo-Controlled Phase III Trial (CLOG1302 study)." Journal of Clinical Oncology 35, no. 31 (November 1, 2017): 3558–65. http://dx.doi.org/10.1200/jco.2017.72.2538.
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Purpose We examined the efficacy and safety of thalidomide (THD) for the prevention of delayed nausea and vomiting in patients who received highly emetogenic chemotherapy (HEC). Patients and Methods In a randomized, double-blind, active-controlled, phase III trial, chemotherapy-naive patients with cancer who were scheduled to receive HEC that contained cisplatin or cyclophosphamide-doxorubicin/epirubincin ≥ 50 mg/m2 regimens were randomly assigned to a THD group (100 mg twice daily on days 1 to 5) or placebo group, both with palonosetron (0.25 mg on day 1) and dexamethasone (12 mg on day 1; 8 mg on days 2 to 4). Primary end point was complete response to vomiting—no emesis or use of rescue medication—in the delayed phase (25 to 120 h). Nausea and anorexia on days 1 to 5 were evaluated by the 4-point Likert scale (0, no symptoms; 3, severe). Quality of life was assessed by the European Organization for Research and Treatment of Cancer QLQ-C30 version 3 questionnaire on days −1 and 6. Results Of 656 patients, 638 were evaluable: 317 in the THD group and 321 in the control group. Compared with placebo, delayed and overall (0 to 120 h) complete response rates to vomiting were significantly higher with THD: 76.9% versus 61.7% ( P < .001) and 66.1% versus 53.3% ( P = .001), respectively. Rates of no nausea were also higher in the THD group (delayed: 47.3% v 33.3%; P < .001; overall: 41% v 29.6%; P = .003), and mean scores of anorexia were lower overall (0.44 ± 0.717 v 0.64 ± 0.844; P = .003). Adverse effects were mild to moderate. The THD group had increased sedation, dizziness, constipation, and dry mouth, but experienced better quality of life after chemotherapy. Conclusion Thalidomide combined with palonosetron and dexamethasone significantly improved HEC-induced delayed nausea and vomiting prevention in chemotherapy-naive patients.
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List, M. A., E. E. Vokes, E. W. Cohen, K. M. Stenson, T. Karrison, B. E. Bruce, M. Witt, and D. J. Haraf. "Performance and side effect evaluation of sequentially reduced radiotherapy doses in a phase II trial of induction chemotherapy (IndCT) followed by concomitant chemoradiotherapy (CTX) for advanced head and neck cancer (HNC)." Journal of Clinical Oncology 24, no. 18_suppl (June 20, 2006): 5558. http://dx.doi.org/10.1200/jco.2006.24.18_suppl.5558.
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5558 Background: CTX regimens are often limited by severe acute toxicities and long-term functional impairment. This paper presents patient (pt) reported side effects and performance outcome in 3 sequential groups of stage IV HNC pts treated at the University of Chicago with IndCT and lowering radiation doses with the goal of maintaining survival while minimizing negative sequelae. Methods: Pts. were treated with IndCT followed by alternating weeks of concurrent CTX with lowering doses of radiotherapy to gross disease/ high risk microscopic/low risk microscopic disease: Group A - 75/60/45 Gy (n = 36 pts); Group B - 75/54/39 Gy (n = 34 pts); Group C - 72/51/36 Gy (n = 60 pts), respectively (treatment details & survival analyses presented separately). Pts were assessed for quality of life, performance (Performance Status Scale for HNC) and side effects (Radiotherapy Questionnaire) pretreatment, during CTX, at 3 & 12 months and annually thereafter. Controlling for baseline scores, differences between the groups were examined on- treatment and at 12-months. Results: Baseline and 12-month data were available for 81/114 pts. While all pts declined in performance (e.g., diet) and reported increased side effects (e.g., dry mouth, mouth pain, swallowing problems) on CTX, there were no statistically significant differences based on radiation dose. Similarly, there was improvement in most symptoms by 12 months with little difference among groups. In contrast, on normalcy of diet, fewer patients in Group C (20%) showed declines of more than 20 points from baseline compared to A (46%; p = .085) and B (45%, p = .09). Overall, 4% of patients were unable to take anything orally at 12-months with no difference among groups. Conclusions: This study showed no differences in pt reported symptoms on-treatment or at 12-months based on lowered radiation doses during CXT. On the other hand, while there continued to be some restriction in long-term diet, pts in the lowest radiation dose group showed somewhat less decline from baseline. These findings suggest the continued need to explore ways of decreasing both acute and long term toxicities in the use of CTX regimens. [Table: see text]
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Sailors, Mary H., Xin Shelley Wang, Ping Liu, Valen E. Johnson, James M. Reuben, Evan N. Cohen, Loretta A. Williams, Tito R. Mendoza, and Charles S. Cleeland. "Longitudinal relationship between inflammatory markers and patient-reported symptom severity during induction therapy for multiple myeloma." Journal of Clinical Oncology 30, no. 15_suppl (May 20, 2012): 9083. http://dx.doi.org/10.1200/jco.2012.30.15_suppl.9083.
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9083 Background: Multiple myeloma (MM) patients undergoing induction therapy experience both disease- and therapy-related symptoms. We investigated the association between the trajectory of symptom severity and changes in levels of inflammatory markers. Methods: MM patients (N=62) rated symptoms via the M. D. Anderson Symptom Inventory (MDASI) twice a week during induction therapy. Patients contributed serum samples before the start of every chemotherapy cycle. A panel of pro- and anti-inflammatory cytokines and markers was evaluated by Luminex. Ordinal regression analyses were used to describe the relationship between cytokines and symptom outcomes across time. These analyses were adjusted for patient and clinical factors (age, sex, diabetes diagnosis, anemia, BMI, comorbidity, staging, ECOG PS, prior treatment status, tumor response, opioid use, and chemo regimen). Results: Bortezomib-based induction therapy was received by 89% of the sample. Fatigue was persistently the most severe symptom during induction therapy, followed by disturbed sleep, muscle weakness, pain, drowsiness, and bone aches. Numbness, which is representative of chemotherapy-induced peripheral neuropathy, significantly worsened from baseline (p=0.01). We observed significant longitudinal associations between sIL-1R1 and distress and sadness (both p=0.02); between sIL-6R and disturbed sleep (p=0.001), poor appetite (p=0.04), and sore mouth (p=0.006). IL-6 was significantly associated with pain, fatigue, nausea, and sore mouth (all p<.05). A negative association between sTNF-RII and pain, sleep, distress, remembering, poor appetite, and nausea (all p<0.05) was also observed. MCP-1 was positively associated with numbness (p=0.04); while MIP-1α was negatively associated with sleep, numbness, constipation, poor attention (all p<0.01), and bone aches (p=0.0006). IL-10 was negatively associated with mood interference (p=0.04). Conclusions: Frequent assessment can document the longitudinal course of multiple symptoms during induction and provides opportunity to evaluate systemic inflammation as a potential source of symptom burden during induction therapy for MM.
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Johnson, D. H., F. A. Greco, J. Strupp, K. R. Hande, and J. D. Hainsworth. "Prolonged administration of oral etoposide in patients with relapsed or refractory small-cell lung cancer: a phase II trial." Journal of Clinical Oncology 8, no. 10 (October 1990): 1613–17. http://dx.doi.org/10.1200/jco.1990.8.10.1613.
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Twenty-two patients with recurrent small-cell lung cancer (SCLC) were treated with single-agent etoposide 50 mg/m2/d by mouth for 21 consecutive days. Eleven patients had received previous chemotherapy with cyclophosphamide, doxorubicin, and vincristine (CAV) or etoposide (CAE) or both (CAVE). Four of the latter patients also received salvage treatment with cisplatin and etoposide (EP). Nine patients had been treated with EP as induction therapy, while two patients had received high-dose cyclophosphamide, etoposide and cisplatin (HDCEP). Altogether, 18 patients had received previous intravenous etoposide. The median time off chemotherapy was 4.5 months (range, 1 to 28.9 months). Ten patients (45.5%; 95% confidence interval [CI], 27% to 65%) achieved a complete or partial response. Responses were most common in patients who had responded to previous chemotherapy and who had not received any treatment in the 90 days before initiation of oral etoposide. Median response duration was 4 months (range, 1.5 to 9.5 months) and median survival was 3.5+ months (range, 1.0 to 15+ months). Leukocyte and platelet nadirs were 1,800/microL and 160,000/microL, respectively, during cycle 1 of treatment and occurred between days 21 and 28. Overall, total leukocyte count decreased to less than 1,000/microL during 10 of 56 cycles (18%). Five patients required six hospitalizations for neutropenia and fever. There were two toxic deaths due to sepsis. Platelet counts less than 50,000/microL occurred in 14 cycles (25%). Alopecia developed in all patients; gastrointestinal toxicity was uncommon. This schedule of etoposide administration warrants further study in combination with other active agents in previously untreated patients with SCLC.