Purpose of review Pain continues to be a prevalent symptom in cancer patients. Patient's ethnicity may influence the experience of pain with variations in pain outcomes among different ethnic groups. The objective of this thematic review is to investigate the relationship between ethnicity and cancer pain experience, assessment and management. Recent findings Cancer pain is not only a biophysiological construct but is rather a multidimensional concept of physiological and psychosocial responses, including the biocultural dimension. Culture can significantly affect patients’ cancer pain-related beliefs and behaviors and patient's ethnicity may influence the experience of pain. We found a scarcity of data and an inconsistent literature that highlights gaps in knowledge, research and clinical practice concerning effective cancer pain management in a multicultural context. Summary To face disparities among ethnic minorities in cancer pain management, well-designed randomized controlled trials and robust qualitative research on cancer pain-related issues should inform good clinical practice. A close worldwide collaboration between researchers and clinicians and professional organizations is warranted.
Purpose of reviewHepatosplenic lymphoma (HSTCL) is a rare T-cell malignancy occurring in young males, associated with immune deficiency in 20% of the cases which, despite aggressive treatments, has a poor survival. Specific recommendations for first-line treatment remain debatable. Recent findingsPublished data covering case reports or series of HSTCL concur that allogeneic stem cell transplant should be proposed as a consolidation after response to chemotherapy in all patients eligible for transplant. In the light of two recent clinical examples, we also confirm that specific chemotherapy and a first-line consolidation with allogeneic transplantation when a donor is available to represent a treatment of choice these rare and distinctive lymphomas. Recent molecular studies are summarized in this review and suggest potential targets for new therapeutic strategies.
To eliminate the burden of health disparities and ensure the best outcomes in MEM's cancer patients, a collaborative approach from research and clinical practice is necessary. Only robust research from all countries exploring unmet needs of MEMs and striving for functional understanding can inform and innovate clinical practice.
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Background Patients with haematologic malignancies are increasingly treated by oral anticancer medications, heightening the challenge of ensuring optimal adherence to treatment. However, except for chronic myelogenous leukaemia or acute lymphoid leukaemia, the extent of non-adherence has rarely been investigated in outpatient settings, particularly for migrant population. With growing numbers of migrants in Belgium, identifying potential differences in drug use is essential. Also, previous research regarding social determinants of health highlight important disparities for migrant population. Difficulties in communication between health caregivers and patients from different cultural and ethnic backgrounds has been underlined. Methods Using a sequential mixed method design, the MADESIO protocol explores the adherence to oral anticancer medications in patients with haematological malignancies and among first and second generation migrants of varied origin. Conducted in the ambulatory setting, a first quantitative strand will measure adherence rates and associated risk factors in two sub-groups of patients with haematological malignancies (group A: first and second generation migrants and group B: non-migrants). The second qualitative strand of this study uses semi-structured interviews to address address the patients’ subjective meanings and understand the statistical associations observed in the quantitative study (strand one). MADESIO aims to provide a first assessment of whether and why migrants constitute a population at risk concerning adherence to oral anticancer medications. Discussion Our protocol is designed to provide a comprehensive understanding of adherence in a specific population. The methodological choices applied allow to explore adherence among patients from diverse linguistic and cultural backgrounds. A particular emphasis has been paid to minimize the biases and increase the reliability of the data collected. Easily reproductible, the MADESIO design may help healthcare services to screen adherence to Oral anticancer medications and to guide providers in choosing the best strategies to address medication adherence of migrants or minority diverse population.
BACKGROUND: Between January 2007 and December 2014, we transplanted 143 patients (Pts) using RIC- conditioning allogeneic transplant. 71 were transplanted for acute leukemias (AML and ALL) and high risk myelodysplastic syndromes (MDS) not eligible for myeloablative transplantation. Clinicians are usually scared to transplant older patients with MUD because of the higher risk of Treatment-related mortality (TRM). We thus reviewed retrospectively the impact of donor / recipient ages and donor-choice (familial related donor (RD) versus matched unrelated donors (MUD)) on the post-transplant outcome of the pts. POPULATION AND METHODS: We retrospectively studied in our cohort of 71 leukemia pts evaluable after RIC transplant, the overall survival (OS) and event-free survival (EFS), according to recipient ages (≤ 54yo vs ≥55yo) and donor types (RD vs MUD). Conditioning consisted of combinations of Busulfan-Fludarabin-ATG or Endoxan-Fludarabine-ATG. Immunosuppression was a combination of cyclosporine (CSA)/mycofenolate mofetil (MMF), Tacrolimus (TAC)/ MMF or TAC/ Sirolimus. Chimerism analyses were performed on d30, d90 and d180. Both study-groups were well balanced concerning transplant conditioning regimens, (ATG or not) RD vs MUD donors, type of leukemia and status of the disease at transplant. Our local EBMT database was the source for this analysis. RESULTS: 34 de novo AML (20 ≤54 yr and 14 ≥55 yr), 30 secondary AML and MDS (15 ≤54 yr and 15 ≥55 yr) and 7 ALL (5 ≤54 yr and 2 ≥55 yr) were enrolled in our trial. 24 pts received HLA identical RD in the group ≤54yr and 14 pts in the group ≥55 yr. The others pts received MUD transplant from HLA 9 or 10/10 donors (16 in the group ≤ 54yr and 17 in the group ≥ 55yr). The median follow-up was 22 (3-93) months. Engraftment rate was 100% in the studied cohort. TRM before d100 was 18,3% (15% ≤54 yo and 22,6% ≥ 55yo). Grade II-IV Acute GVHD (aGVHD) at d90 (16,6%) and Chronic GVHD rates (24%) were similar in both age populations. 5 yrs OS was not different according to the age of the recipient (≤54 yr versus ≥55 yr)(p = 0.9). However, there is a clear, difference in 5years OS when stratifying the two age groups according to donor-types, especially for older patients (≥55 yr) with MUD transplant. (pts ≤ 54yr : OS: RD: 31,6%; and MUD: 38%; pts ≥ 55yr : OS: RD: 27,8% and MUD 44,2%). This trend in a better OS in older MUD pts could be explained partially by a lower relapse-rate in the group ≥ 55 yr with a MUD as shown by EFS/5yrs (pts ≤ 54 yr : RD: 32%; ≤ 54yr MUD: 19%; pts ≥ 55yr RD: 21% and ≥ 55yr MUD 38,5 %). As reported already in transplanted CLL patients, this suggests a greater GVHD/GVL-effect in the MUD transplantation. We then further investigated the age of the donors and its correlation with aGVHD and cGVHD. In the RD RIC transplant group, median age of the donors was 49 yrs (range 35-69 years) with 37.5% of aGVHD and 42% of cGVHD. In the MUD RIC transplant cohort, donor median age was 31 yrs (20-55 years) with 12% of aGVHD and 32% of cGVHD. We previously reported that the number of CD8+ T cells and naïve CD4+ T cells decreases with the age of the donor, also supporting a better control of the disease with younger donors. This combination of younger donor age, lower aGVHD and a similar rate of cGVHD clearly explains the better outcome in pts transplanted with MUD. Our data requires confirmation in a larger series of patients. CONCLUSION: our observations confirm that: 1) RIC transplantation is a curative approach in acute leukemia whatever the age when the pts are fit enough to tolerate the transplant. 2) despite a higher TRM compared to younger patients, older patients seem to particularly benefit from MUD in terms of OS. 3) an increased EFS is observed in older pts transplanted with MUD (also younger) donors more likely due to a greater GVHD/GvL effect in the MUD setting. Disclosures No relevant conflicts of interest to declare.
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