UDS on the 82 oncology patients at high risk for substance misuse were frequently positive (46%) for non-prescribed opioids, benzodiazepines or potent illicit drugs such as heroin or cocaine, and 39% had inappropriately negative UDS, raising concerns for diversion.
Purpose High-throughput chemosensitivity testing of low-passage cancer cell lines can be used to prioritize agents for personalized chemotherapy. However, generating cell lines from primary cancers is difficult, because contaminating stromal cells overgrow the malignant cells. Experimental Design We produced a series of hypoxanthine phosphoribosyl transferase (hprt)-null immunodeficient mice. During growth of human cancers in these mice, hprt-null murine stromal cells replace their human counterparts. Results Pancreatic and ovarian cancers explanted from these mice were grown in selection media to produce pure human cancer cell lines. We screened one cell line with a 3,131-drug panel and identified seventy-seven FDA approved drugs with activity, including two novel drugs to which the cell line was uniquely sensitive. Xenografts of this carcinoma were selectively responsive to both drugs. Conclusion Chemotherapy can be personalized using patient-specific cell lines derived in biochemically selectable mice.
Background-Pancreatic cancer is a disease of near uniform fatality and the overwhelming majority of patients succumb to their advanced malignancy within a few months of diagnosis. Despite considerable advances in our understanding of molecular mechanisms underlying pancreatic carcinogenesis, this knowledge has not yet been fully translated into clinically available treatment strategies that yield significant improvements in disease free or overall survival.Objective-Cell line-based in vitro model systems provide powerful tools to identify potential molecular targets for therapeutic intervention as well as for initial pre-clinical evaluation of novel drug candidates. Here we provide a brief overview of recent literature on cell line-based model systems of pancreatic cancer and their application in the search for novel therapeutics against this vicious disease.Conclusion-While in vitro models of pancreatic cancer are of tremendous value for genetic studies and initial functional screenings in drug discovery, they carry several imanent drawbacks and are often poor in predicting therapeutic response in humans. Therefore, in most instances they are successfully exploited to generate hypothesis and identify molecular targets for novel therapeutics, which are subsequently subject to further in-depth characterization using more advanced in vivo model systems and clinical trials.
Thirty-day readmission (30-DR) has become an important quality-of-care measure. Allogeneic hematopoietic cell transplantation (allo-HCT) presents a medical setting with higher readmission rates. We analyzed factors affecting 30-DR and its impact on patient outcomes and on health care costs in 91 patients who underwent reduced-toxicity conditioning (RTC) allo-HCT with fludarabine and busulfan. The patient cohort was divided into 2: the readmission group (R-gp) or the no-readmission group (NR-gp). Overall, 38% (n = 35) required readmission with a median time to readmission of 14 days. In multivariate analysis, only documented infection during the index admission predicted 30-DR, P =.01. With a median follow-up of 18 months (range, 1 to 69) for surviving patients, the 2-year overall survival was 49% and 58% in the R-gp and NR-gp respectively, P =.48. The 1-year nonrelapse mortality in R-gp and NR-gp was 18% and 13% respectively, P =.43. The median post-transplantation hospital charges in the R-gp and NR-gp were $85,115 (range, $32,015 to $242,519) and $45,083 (range, $10,715 to $485,456), P = .0002. In conclusion, only documented infections during the index hospitalization influenced 30-DR after RTC allo-HCT. Although 30-DR did not adversely affect mortality or survival, it was associated with significantly increased 100-day post-transplantation hospital charges, thus supporting its role as a quality-of-care measure in allo-HCT patients.
PurposeResearch in palliative care demonstrates improvements in overall survival, quality of life, symptom management, and reductions in the cost of care. Despite the American Society of Clinical Oncology recommendation for early concurrent palliative care in patients with advanced cancer and high symptom burden, integrating palliative services is challenging. Our aims were to quantitatively describe the palliative referral rates and symptom burden in a South Texas cancer center and establish a palliative referral system by implementing the Edmonton Symptom Assessment Scale (ESAS). MethodsAs part of our Plan-Do-Study-Act process, all staff received an educational overview of the ESAS tool and consultation ordering process. The ESAS form was then implemented across five ambulatory oncology clinics to assess symptom burden and changes therein longitudinally. Referral rates and symptom assessment scores were tracked as metrics for quality improvement.
215 Background: The growing support for integrated palliative and cancer care resulted in the American Society of Clinical Oncology’s new recommendation which states patients “with advanced cancer should receive dedicated palliative care services, early in the disease course, concurrent with active treatment.” Unfortunately, timely access to palliative services remains an issue for cancer patients and centers. The aim of this project is to evaluate how socioeconomic factors impact palliative access for patients in South Texas. Methods: During a 6-month period, patients in oncology clinics completed the Edmonton Symptom Assessment System questionnaire. Scores reaching a predetermined threshold resulted in a provider alert to consider referral to palliative services. We examine time to initial palliative appointment after referral and compare time to visit based on location of palliative services determined by insurance coverage. Results: During our study period, providers referred 47 unique patients with 27 patients eligible to receive care at the University of Texas Medicine System (Group A) and 20 patients qualified for care at the University Hospital System providing services to under-insured and safety net patients (Group B). Of the 47 referred patients, 27 (57%) patients were offered an appointment and only 17 patients (36%) actually had a palliative care visit (13/27 (48%) Group A patients and 4/20 (20%) Group B patients). On average, Group B patients had 25.2 days longer wait times to palliative visits compared to Group A patients. Conclusions: This investigation revealed a discrepancy between referral and actual receipt of care. While this study is limited by a small sample, data suggests that under-insured oncology patients may have significantly different access to palliative services which may impact the quality of cancer care. [Table: see text]
Appendicitis in leukemic patients is uncommon but associated with increased mortality. Additionally, leukemic cell infiltration of the appendix is extremely rare. While appendectomy is the treatment of choice for these patients, diagnosis and management of leukemia have a greater impact on remission and survival. A 59-year-old Caucasian female was admitted to the surgical service with acute right lower quadrant pain, nausea, and anorexia. She was noted to have leukocytosis, anemia, and thrombocytopenia. Abdominal imaging demonstrated appendicitis with retroperitoneal and mesenteric lymphadenopathy for which she underwent laparoscopic appendectomy. Peripheral smear, bone marrow biopsy, and surgical pathology of the appendix demonstrated acute myeloid leukemia (AML) with nonsuppurative appendicitis. In the setting of AML, prior cases described the development of appendicitis with active chemotherapy. Of these cases, less than ten patients had leukemic infiltration of the appendix, leading to leukostasis and nonsuppurative appendicitis. Acute appendicitis with leukemic infiltration as the initial manifestation of AML has only been described in two other cases in the literature with an average associated morbidity of 32.6 days. The prompt management in this case of appendicitis and AML resulted in an overall survival of 185 days.
Autologous hematopoietic cell transplantation (auto-HCT) is considered the standard approach for relapsed or refractory non-Hodgkin lymphoma (NHL). 1 The therapeutic rationale for auto-HCT is the delivery of myeloablative doses of chemotherapy and/or radiation without overlapping toxicities, thus increasing the response of the resistant lymphoma cells. Relapse/progression of lymphoma and to a lesser extent non-relapse mortality (NRM) remain limitations to treatment success. Although several conditioning regimens are available, including the commonly utilized BEAM (carmustine, etoposide, cytarabine, melphalan) 2 and CBV (cyclophosphamide, carmustine, etoposide), 3 there is no general consensus regarding a standard conditioning approach in lymphoproliferative disorders. Thiotepa is an alkylating agent with potent anti-lymphoma properties, making it an attractive agent for high-dose chemotherapy and auto-HCT. Thiotepa was originally used as part of preparative regimens for solid tumor malignancies, such as breast and ovarian cancer. 4 Owing to thiotepa's excellent central nervous system (CNS) penetration, it has increasingly been evaluated in CNS malignancies, including lymphoma. 5-7 Several thiotepa-based regimens, typically combined with etoposide, 8-11 carboplatin, 9,11-13 mitoxantrone, 11,12 busulfan 11,14,15 or melphalan, 11,13-15 have shown activity in lymphoma patients with or without CNS involvement. To our knowledge, there are no reports of the specific combination of thiotepa, etoposide and cyclophosphamide (VP/Cy/TT) as a conditioning regimen for NHLs. Here we report the long-term outcomes with this conditioning regimen for auto-HCT in patients with NHL. This single center retrospective study was approved by the Institutional Review Board at West Virginia University. Consecutive adult (age 18 years or older) NHL patients undergoing auto-HCT after conditioning with VP/Cy/TT were eligible for this study between 1997 and 2009. The conditioning regimen consisted of etoposide (1800 mg/m 2 IV over 27 h) on day − 10, thiotepa (300 mg/m 2 IV) on days − 8 to − 6 and cyclophosphamide (50 mg/kg IV) on days − 5 to − 2. In June 2002, after the first 10 patients, the regimen was changed to etoposide (1800 mg/m 2 IV over 27 h) on day − 7, thiotepa (250 mg/m 2 IV) every morning on days − 5 to − 2 and cyclosphosphamide (50 mg/kg IV) every evening on days − 5 to − 2. PBSC were mobilized using cyclophosphamide and filgastrim. All patients in the revised regimen after June 2002 received filgrastim support post transplant along with prophylactic levofloxacin, acyclovir and fluconazole. Transfusion support and management of febrile neutropenia were provided per institutional protocol. CR was defined as the resolution of all disease by imaging or biopsy when indicated. PR was defined as a reduction of tumor burden by at least 50%. Engraftment was defined as the first of 3 consecutive days with an ANC4500 cells/mm 3. Platelet recovery was defined as the first of 7 consecutive days with the platelet count 420 000/mm 3 without a p...
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