6089 Background: Febrile neutropenia (FN), a dose-limiting event for many myelosuppressive chemotherapy (CT) regimens, often causes subsequent CT dose delays (DD) and reductions (DR), lengthens hospital stay and increases monitoring, diagnostic and treatment costs. No studies are known to date on economic costs of FN in common clinical practice in Spain. Methods: This is a multicentre, retrospective, observational chart review of adult patients with breast cancer, lung cancer or non-Hodgkin’s lymphoma (NHL) who suffered from at least one FN episode related to cytotoxic CT from 16 Spanish hospitals. Resource use and subsequent costs including days of hospitalization, number of RBC transfusions, number and type of complementary tests, use of colony-stimulating factors (CSF), antibiotics and other drugs to manage FN were assessed. Potential impact of FN on planned CT dose and/or schedule was also analysed. P-value was obtained by one-way ANOVA using the Bonferroni correction. Results: A total of 194 medical charts including 238 documented FN episodes were reviewed. Women, 59.8%; age > 60 yrs, 49.5%; breast cancer, 43% (83% treated with taxane or anthracycline-based CT); lung cancer, 22% (95.5% treated with platinum-based CT); NHL, 35% (58.2% treated with CHOP-like CT). Hospitalization due to FN lasted a median of 7 days. During the episode, 32.3% of pts needed 1 or more RBC transfusions, 97.9% required a blood test and 87% a blood culture. CSFs were used in 67.6% of pts. All pts were treated with antibiotics and 78.2% with other drugs. 58.4% of FN episodes had an impact on planned CT dose and/or schedule: DR was observed in 34.9% of cases, DD in 28% and CT withdrawal in 14.7%. Conclusions: Main drivers of cost of FN are hospitalization and antibiotic treatment. FN is more costly in NHL pts than breast or lung pts (statistically significant in lung pts). FN episodes have a relevant impact on planned CT dose and/or schedule. In each row statistically significant differences ( p<0.05) were obtained between values with the same letter. [Table: see text] [Table: see text]
The aim of this paper is to provide a simple method for the definition of a rudder for tuna purse seiners. The model achieved by the application of this method ensures the manoeuvrability of initial turning, course keeping and yaw checking. For this, the results obtained by other authors, through rudder tests and manoeuvrability tests of fishing vessels have been integrated with the recommendations of the International Normative. Finally, in the paper the method is applied to the case of a tuna vessel, providing a rudder model which could be optimised with CFD (Computer Fluid Dynamics) in further tests. The method proposed can be applied to other vessels whose main dimensions are met.
Introduction: Colorectal cancer treatment requires a complex, multidisciplinary approach. Because of the potential variability, monitoring through clinical audits is advisable. This study assesses the effects of a quality improvement action plan in patients with locally advanced rectal cancer and treated with radiotherapy. Methods: Comparative, multicentre study in two cohorts of 120 patients each, selected randomly from patients diagnosed with rectal cancer who had initiated radiotherapy with a curative intent. Based on the results from a baseline clinical audit in 2013, a quality improvement action plan was designed and implemented; a second audit in 2017 evaluated its impact. Results: Standardised information was present on 77.5% of the magnetic resonance imaging (MRI) staging reports. Treatment strategies were similar in all three study centres. Of the patients whose treatment was interrupted, just 9.7% received a compensation dose. There was an increase in MRI re-staging from 32.5 to 61.5%, and a significant decrease in unreported circumferential resection margins following neoadjuvant therapy (ypCRM), from 34.5 to 5.6% (p < 0.001). Conclusions: The comparison between two clinical audits showed improvements in neoadjuvant radiotherapy in rectal cancer patients. Some indicators reveal areas in need of additional efforts, for example to reduce the overall treatment time.
Introduction The role of antiangiogenic therapy in primary hormonal therapy in HER2-negative ER-positive early breast cancer is unknown. Potential biomarkers of response to antiangiogenic therapy are lacking. A phase I clinical trial was conducted with sunitinib and exemestane given at conventional dose (25 mg/d) during 6 months, before surgery. 18 patients were enrolled, 15 in dose level 0 of sunitinib (25 mg/d) and 3 in dose level 1 (37.5 mg/d). Results were presented in SABCS 2011. Main toxicities were: asthenia (50%), leucopenia (28%, all grade 2), diarrhea (28%), mucositis (22%), and hypertension (22%). 10 patients achieved radiological partial response (56%) and 8 patients stable disease (44%). 7 patients (38.89%) obtained a pathological downstaging. Potential biomarkers of response to antiangiogenic therapy are presented. Materials and methods Tissue samples were obtained by fine-needle aspiration or core needle biopsy before starting treatment, one month after and at surgery. All samples were formalin-fixed paraffin-embedded. Ki67, phospho-ERK and mean vessel density (by CD34), were analyzed by immunostaining. At the same time points, plasma levels of angiopoietin 2 (ANG2), soluble VEGFR2 and VEGF were analyzed by ELISA. Basal levels and its changes over time were evaluated and correlated with clinical outcomes. Results Changes in Ki67 were observed, with a median value of 16.44%pre surgery and 12.78% post surgery (p=0.062). A significant decrease in mean vessel density was not observed. Basal levels of plasmatic biomarkers are shown in the next table: Basal levels of plasmatic biomarkers SDPRpPath DownstNo Path DownstpANG 22396+/-6503455+/-13940.083184+/-16102818+/-7680.6VEGF110+/-12577+/-660.5794+/-6388+/-1210.9VEGFR210570+/-22512110+/-43940.3512140+/-432110980+/-31960.55 Values of biomarkers are average in ng/ml ± Standard Deviation. Differences analyzed by student's t-test. Abreviations: SD= stable disease. PR= partial response. p = p value. Path. Downst.= Pathological downstaging. Furthermore, there was a significant decrease in VEGFR2 mean levels after one month of treatment (p=0.0046): 12284±3449 ng/ml at baseline; 8148±3216 ng/ml at one month and 7732±3052 ng/ml at 6 months. Differences between basal and one month determination were significant (p<0.01), but no differences were seen between 1 month and 6 months, showing a relevant early decrease of VEGFR2 plasma levels. In contrast, levels of VEGF did not change significantly over time and had no association with clinical outcomes. Conclusions Baseline ANG2 levels have a promising predictive value of response in this phase I trial of neoadjuvant combination of sunitinib plus exemestane. There is a significant early decrease in VEGFR2 with treatment with sunitinib. These results should be validated in further studies to improve the selection of patients for antiangiogenic+hormonal therapy. Citation Format: Helena Verdaguer, Serafin Morales, Valentí Navarro, Alba Martinez Lopez, Anna Petit, Fina Climent, Oriol Casanovas, Sònia Pernas. Potential biomarkers of response to primary antiangiogenic and hormonal therapy in post-menopausal women with hormone-positive, HER2-negative primary breast cancer [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P6-01-05.
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