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Linear accelerators (linacs) became widely available in the 1960s and with them treatment lung cancer cheap chloromycetin 500 mg otc, the need for measuring and controlling the delivered dose treatment venous stasis buy 250 mg chloromycetin with mastercard. Radiotherapy using electron beams was also available medications information buy 500mg chloromycetin otc, opening a new and challenging way to deliver radiation medicine 74 chloromycetin 250 mg for sale. The possibility of determining the target, the lymphatic pathways involved and the neighbouring organs that could be affected demanded new knowledge and skills from the radiation oncologist. The use of various beam arrangements was considered in order to cover volumes better and to save more healthy tissue. However, there were still some difficulties irradiating targets close to sensitive structures such as the brain and spinal cord. In the process, the long supported paradigm that a beam arrangement should deliver a homogeneous dose to the target was challenged. This was only possible because tools became available to verify the calculated plans on high performance phantoms or 160 chamber arrangements. The positioning and immobilization of patients improved, becoming accurate to within millimetres. With the dose delivery reaching a precision of the order of a few millimetres, patient and organ movements now became a critical issue. The movement of organs (and tumours), which was not a critical issue in the two dimensional (2-D) radiotherapy era, became critical when a very accurate system was delivering a very precisely defined high dose, but to the wrong volume. A major improvement is the possibility of shaping doses into invaginations of the target. Implementation of this treatment modality is not simple and requires a completely new staff approach [10. To try them all until the best fitted one is found would be a very cumbersome and almost impossible task without the aid of a computer program. Therefore, this task is carried out by the planning software using an inverse planning approach. It is not necessarily a modality reserved only for curative treatments, but the patients must be able to support long immobilization times and should be cooperative [10. Patient positioning and immobilization are some of the most important aspects of the process [10. Positioning must not only be reproducible but very accurate, and organ immobilization systems or devices are often required. In addition to the anatomical area to be treated, the required volume must be determined in case non-coplanar beams are deemed necessary. Sometimes, regions located far from the treatment volume must be specified to avoid overdosing. Delineation and contouring of targets and organs have become a new and important component in the training of radiation oncologists. The fact that different specialists will draw different volumes for the same patient is well known (inter-observer variations), and the development of atlases for this purpose is recommended [10. The desired doses and dose constraints must be clearly communicated, because the inverse calculation will produce many possible solutions, some better and some worse, until the goal is achieved. Special attention must be paid to the fact that too many beams or too many segments can protract the fraction too long, leading to immobilization difficulties [10. The choice of the optimal one for the individual patient is made by the radiotherapy team. Verification of the plan is of paramount importance; all steps in the process must be recorded thoroughly and an independent dose calculation method should be used to verify the doses [10. Dose comparisons among centres in order to validate the entire process are encouraged [10. In the past, this property was widely exploited as a set-up verification method, assuming that the bony anatomy could be a good reference for the planned treatment volume. Sometimes other fiducial markers were placed to help define the target volume, such as metal clips in the surgical tumour bed [10. With technological advances and better target definition has come the need for more accurate patient positioning, allowing more precise dose delivery. The patient is then moved to the congruent position before the treatment is delivered [10. This can be kilovolt or megavolt imaging using fiducial markers, ultrasound, or kilovolt or megavolt scan images, allowing for different levels of precision. It is very important to be aware of the capability of the method that is being implemented and the particular constraints it can impose, such as operator ability in the case of ultrasound imaging. Depending on the target, there will be some imaging modalities that may or may not fit the requirements. If the aim is to correct only for interfraction displacements (set-up differences), the modalities can be different from the ones chosen for intrafraction movements, such as for stereotactic body radiotherapy. Sometimes, different modalities must be combined to ensure the correct visualization of the target position. Clear guidelines should be developed and be made available in each centre, establishing the threshold for patient displacement and action levels allowed to each staff member [10. Therefore, clinical trials are encouraged in order to demonstrate whether these new efforts are worthwhile [10. As a result, a major debate about the real impact of the new technologies arose very early on to clarify whether these investments are worth their cost. Other publications showed encouraging results in the treatment of prostate cancer, a very common cancer recognized as a dose dependent tumour susceptible to control by dose escalation [10. There is still room for improvement, including learning how to better define targets and learning from the pathophysiology of saliva secretion and swallowing functions. The traditional opposed tangential, wedged fields have been used since the 1980s, allowing better sparing of lung tissue, but sometimes the dose distribution is not as good as is desired. Treatment of large breasts, the left breast (due to the presence of the heart in the high dose volume) or patients who also require elective lymph node irradiation represents a challenge to dosimetrists. This may be because of the difficulty of reflecting in publications the subjective changes in treatment quality and patient quality of life. Class solutions or geometrical solutions used to treat almost all patients in a given anatomical region. In an attempt to find the best way to treat prostate cancer, a comparison of different available approaches and methods has been published. They showed that noncompliance with the radiotherapy plans had a major negative impact on the treatment results. The patient group with the compliant plans had a two year overall survival rate of 70%, compared with 50% for those patients with major deviations from the requested radiotherapy. The authors also showed that the centres enrolling more patients (over 20) had a better compliance rate than those centres enrolling fewer than five patients. Interestingly, the authors concluded that the effect of a good radiotherapy technique overrides the effect of the added chemotherapy drugs, which in many cases add an important economic burden to the treatment. The impact of dose escalation has been proved, and the quest to deliver even higher doses to the prostate gland continues. If we consider that a cancer can only be cured if all cancer clonogenic cells are eradicated, then the logical explanation is that we are not eliminating all these clonogenic cells with our current techniques. An important clonogenic cell hiding place is the lymph nodes, and this might be the reason why we cannot achieve better disease control. An important proportion of prostate sentinel lymph nodes are located outside the obturator and external iliac regions, thus not following an expected drainage pattern [10. While better technology is available, and while it is ideal to be able to use it to benefit patients, completely new hazards are emerging with it. The New York 166 Times reported a radiotherapy accident that occurred in New York in relation to the use of these new technologies [10. Computerized treatment planning is an important field that provides significant benefits, but it can also be a source of great difficulties. Vendors often upgrade computer planning and operating systems, and sometimes the new releases do not allow previously installed programs, or parts of them, to run as expected. Modern radiotherapy departments are often part of a hospital network, sharing useful information, but also computer viruses. Many medical software vendors do not recommend the use of networks, but this is hardly practical in this day and age.
Initial results were published in 2010 at which time data was presented on 2232 patients symptoms your having a boy discount chloromycetin 250 mg online, 862 who had a median follow up of 4 years and 1514 who had a median follow up of 3 years medicine neurontin effective 250mg chloromycetin. Until the data are more mature treatment irritable bowel syndrome generic chloromycetin 500 mg amex, 50-kV patients should be treated under strict institutional protocols treatment of shingles discount chloromycetin 250mg free shipping. Palliation Primary therapy for women with metastatic breast cancer (M1 stage) is systemic therapy. Evidence is limited with regard to the role of locoregional radiotherapy for M1 stage disease in the absence of symptomatic locoregional disease. Breast boost using noninvasive image-guided breast brachytherapy versus en face electrons: a matched pair analysis. The American Brachytherapy Society consensus statement for accelerated partial breast irradiation. All clinically visible lesions confined to the cervix with or without extension to the parametria, pelvic sidewall(s), lower third of vagina, or causing hydronephrosis or nonfunctioning kidney 4. In the non-curative setting and where symptoms are present, palliative external beam photon radiation therapy may be medically necessary. Key Clinical Points Within the United States in 2018, 13,240 new cases of cervical cancer are projected resulting in approximately 4,170 deaths. Dose recommendations are available in the literature of the American Brachytherapy Society. Positive pelvic and/or para-aortic nodes, surgical margins, and involvement of the parametrium are also important. Management of the para-aortic nodes the treatment of para-aortic nodal regions may be indicated in the following clinical situations: A. Devices for the immobilization of the cervix are considered experimental at this time. There is solid evidence that the risk of severe small bowel injury after conventional radiotherapy for postoperative patients with gynecologic cancer is 5 to 15% (Corn et al. Randomized trials have shown an overall survival advantage for cisplatin-based therapy given concurrently with radiation therapy, while one trial examining this regimen demonstrated no benefit. Chemotherapy Radiation Therapy Criteria References 1. Cervix moves significantly more than previously thought during radiation for cancer. Prospective clinical trial of positron emission tomography/computed tomography image-guided intensity-modulated radiation therapy for cervical carcinoma with positive para-aortic lymph nodes. Long-term follow-up of a randomized trial comparing concurrent single agent cisplatin, cisplatin-based combination chemotherapy, or hydroxyurea during pelvic irradiation for locally advanced cervical cancer: a Gynecologic Oncology Group Study. Para-aortic lymph node radiation treatment with pelvic external beam photon radiation therapy with or without brachytherapy is considered medically necessary for either of the following: A. The treatment options for treatment of cancer of the endometrium are defined by stage of disease, grade of the cancer, completeness of surgical staging and the presence of adverse risk factors. Adverse risk factors include advancing age, lymphovascular extension, tumor size, lower uterine involvement classified as cervical glandular involvement (newly classified as Stage I). Endometriod (tumors resembling the lining of the uterus; adenocarcinomas) are the most prevalent subtype. Patients younger than age 60 who received external beam treatment did not have a survival benefit but did suffer an increased risk of secondary cancers with subsequent increased mortality. If positive or suspicious, however, an attempt should be made to either restage surgically or document the presence of metastatic disease. Definitive radiotherapy in the management of isolated vaginal recurrences of endometrial cancer. Randomized Trial of Radiation Therapy With or Without Chemotherapy for Endometrial Cancer Leiden University Medical Center. Among the treatments investigated to improve upon these results is the use of preoperative chemoradiotherapy. As such, the standard-dose arm was associated with a non-significant improvement in median survival (18. On the other hand, the high-dose arm was associated with a non-significant reduction in local-regional persistence or failure (50% vs. Using a fitted multivariate inverse probability weighted-adjusted Cox model, Lin et al. Combined chemotherapy and radiotherapy compared with radiotherapy alone in patients with cancer of the esophagus. Propensity score-based comparison of long-term outcomes with 3-dimensional conformal radiotherapy vs. Intensity-modulated radiation therapy with concurrent chemotherapy as preoperative treatment for localized gastric adenocarcinoma. Three-dimensional non-coplanar conformal radiotherapy yields better results than traditional beam arrangements for adjuvant treatment of gastric cancer. Intensity-modulated radiotherapy combined with chemotherapy for the treatment of gastric cancer patients after standard D1/D2 surgery. Is medically necessary in unresected T2-4a, N0-3 cases utilizing up to 42 fractions with conventional schedule 2. Concurrent chemotherapy carries a high toxicity burden and requires substantial supportive care and the expertise of an experienced multidisciplinary team D. Utilization of radiation therapy should be preceded by workup and staging and planned in conjunction with the appropriate members of a multi-disciplinary team that also includes: diagnostic imaging, pathology, medical oncology; otorhinological, oral, plastic and reconstructive, neuro- and ophthalmologic surgeons; psychiatry; addiction services; audiology and speech therapy; rehabilitation and nutritional medicine; pain management, dentists, prosthodontists, xerostomia management, smoking and alcohol cessation, tracheostomy and wound management, social workers and case management. Initial management may require surgery, chemotherapy, and radiation therapy in various combinations and sequences. Concurrent chemotherapy and intensity-modulated radiotherapy for locoregionally advanced laryngeal and hypopharyngeal cancers. Patterns of failure and toxicity after intensity-modulated radiotherapy for head and neck cancer. The Child-Pugh score is based on laboratory and clinical measures and assigns a patient with cirrhosis into compensated (class A) or uncompensated (class B or C) status. Locoregional therapy may be performed by laparoscopic, percutaneous, or open approach. For each technique, there must be sufficient uninvolved liver such that the technique is capable of respecting the tolerance of normal liver tissue. Those cancers that occur at or near the junction of the right and left hepatic ducts are known as Klatskin tumors and are considered extrahepatic. Extrahepatic bile duct cancer (cholangiocarcinoma) the junction of the right and left hepatic ducts serves as the dividing location of intra-and extrahepatic bile duct cancers. Those more distal may occur anywhere along the common bile duct down to near the ampulla of Vater. As the incidence is low, there is no firmly established role of radiation therapy, though its use is an accepted option in postoperative cases of R0, R1, R2 margins and/or positive nodes. Gallbladder cancer the use of adjuvant radiation therapy after resection appears to be most beneficial in patients with T2 and higher primary tumor status, or if nodes are positive, and is most commonly given concurrent with capecitabine or gemcitabine. T1a and T1b, N0 cases have not been shown to benefit from adjuvant radiation, which may be omitted. Long-term outcomes of stereotactic body radiation therapy in the treatment of hepatocellular cancer as a bridge to transplantation. Prediction model for estimating the survival benefit of adjuvant radiotherapy for gallbladder cancer.
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The authors reported that at a median follow-up time of approximately 34 months medicine interaction checker buy discount chloromycetin 500mg on-line, the addition of chemotherapy to surgery had resulted in a 3-year progression-free survival of 74% compared with 59% in the surgery only group (p < 0 symptoms 0f colon cancer order chloromycetin 250mg online. Although many of the published reports involved Postoperative chemotherapy 56 Clin treatment 20 initiative discount 250mg chloromycetin with amex. D2 dissections involve lymph nodes along the splenic artery (location 10) treatment definition buy 500mg chloromycetin with mastercard, splenichilum (location 13), celiac artery (location 9), left gastric artery (location 7), and common hepatic artery (location 8). D3 dissections include para-aortic (location 11) and posterior hepatoduodenal lymph nodes (location 12). A randomized Dutch trial that included 1078 patients who underwent either D1 or D2 lymphadenectomy demonstrated that at a median follow-up of 15. D2 lymphadenectomies and many others do not explicitly specify the type of surgery performed, the results of the meta-ana lysis by Sun et al. In the case of advanced inoperable gastric cancer, early studies demonstrated a clear and substantial benefit to chemotherapy compared with best supportive care. Randomization was interrupted in the middle of this study once the benefit provided by the chemotherapy regimen became apparent. Meta-analysis of 17 trials totaling 3838 patients demonstrating adjuvant chemotherapy provided improved overall survival (hazard ratio: 0. Another group conducting a pooled ana lysis of irinotecan-containing treatment regimens in comparison with those lacking this agent found a statistically significant benefit in terms of time-to-treatment failure, as well as decreased incidence of gastrointestinal and high-grade hematologic toxicity [101]. However, this study did not find an improvement in overall survival with the inclusion of irinotecan. The ToGa study found a significant increase in median overall survival with the addition of trastuzumab (13. A summary of various chemotherapeutic regimens that have been investigated for the treatment of unresectable gastric cancer is provided in Table 6. Preoperative chemotherapy One of the most important drawbacks of a combination regimen involving both surgery 58 Clin. To address this issue, several groups have explored the possibility of neoadjuvant and perioperative chemotherapy. The patient population included in the study consisted of those with stomach cancer (76%) as well as patients with lower esophageal and esophagogastric cancers (26%). While no differences in postoperative complications were detected, resected tumors among the patients receiving preoperative chemotherapy were found to be significantly smaller and less advanced compared with those in patients who did not receive chemotherapy. In addition, of the 250 patients treated with perioperative chemotherapy, no patient achieved a pathological complete response, which has been suggested to confer a survival benefit [107]. Another study utilizing a neoadjuvant docetaxel-based regimen reported 75% of patients in the preoperative arm tolerating both surgery and chemotherapy, while only 34% of those in the postoperative arm were able to receive both modalities [109]. This study also reported similar postoperative morbidity between the two arms but a tendency for greater incidence of chemotherapy-related serious adverse events in the postoperative chemotherapy arm (23%) versus the preoperative chemotherapy arm (11%; p = 0. This trial found an improvement over surgery alone in 5-year survival (38 vs 24%), 5-year disease-free survival (34 vs 19%) and curative resection rate (84 vs 73%) with similar rates of postoperative morbidity. Among patients receiving neoadjuvant chemotherapy, complete and partial clinical responses were seen in 5. At a median follow-up of 25 months, the authors reported seven out of ten patients without evidence of disease. Early phase clinical trials utilizing various chemotherapy regimens in combination with surgery. An early prospective, randomized controlled trial by the British Stomach Cancer Group allocated patients to receive either surgery alone, surgery and adjuvant radiation or surgery and adjuvant chemotherapy [114]. This study did not find any benefit in the administration of either adjuvant radiation or chemotherapy versus surgery alone and proposed that surgery remains the standard of care. One such trial, by Zhang and colleagues, investigating the potential benefit of preoperative radiation therapy without chemotherapy, noticed improvements in 5-year (30. Of note, patients were required to maintain a caloric intake of at least 1500 kcal/day by either oral or enterostomal alimentation, highlighting the importance of adequate nutrition during treatment for the results of this trial to be generalizable. In addition, the authors of this prospectively designed study reported significantly lower locoregional recurrence in the combination treatment arm (14. However, on subgroup ana lysis, the patients who had lymph node involvement were found to derive a significant benefit in terms of 3-year disease-free survival (77. Therefore, despite a short follow-up period, there were relatively high survival rates and further evaluation of these patients is necessary for recurrence and survival. These investigators found a significant increase in 5-year locoregional control rates (50 vs 35%) and decreased recurrence within the external-beam radiotherapy field for patients receiving intraoperative radiation. However, as would be expected, the authors reported a higher incidence of grade 3 and 4 late toxicity in patients receiving intraoperative radiation, namely enteritis and hemorrhage. However, it should be noted that despite the radiotherapy regimen, 20 Gy in five fractions preoperatively and 20 Gy intraoperative radiation as a single fraction, is not standard. A follow-up study by the same group also found no increase in the rate of surgical complications such as anastomotic leakage and wound infection, a complementary finding to that of Valenti et al. The authors reported grade 3 late radiation effects in only 5% of patients and 21% experienced grade 4 toxicity, notably thrombosis, fatigue, anorexia, diarrhea and vomiting [107]. Another recent meta-analysis by Valentini and colleagues analyzed nine Preoperative radiation therapy future science group An important point of any preoperative regimen is that it allows for the selection of patients who may experience metastatic disease during this time and may not benefit from surgery. There is ongoing work investigating novel combinations of radiation and chemotherapy. Radiation therapy for unresectable gastric cancer While radiotherapy has been demonstrated to be beneficial in the treatment of resectable gastric cancer, several studies have also demonstrated a benefit of radiation in combination with chemotherapy in the management of patients with inoperable disease. A meta-analysis of nine randomized controlled trials taking place over a total of 25 years evaluated the effect radiotherapy (pre-, post- or intra-operative) on 3- and 5-year survival. Preoperative radiotherapy was found to have a statistically significant effect on 5-year survival, by both intention to treat (relative risk of survival: 1. These side effects prompted investigation into other modalities of radiation delivery that may potentially reduce therapy-associated toxicity. This study addresses the importance of avoiding excessive, even lowdose, irradiation of the kidney as long-term, clinically significant nephropathy can occur with a latency of up to 15 years [135]. Additional benefits included a lower volume of the liver receiving radiation, a lower volume of irradiated small bowel, and a lower dose delivered to the spinal cord [137]. Intensity-modulated radiation therapy versus 3D-conformal radiation therapy for gastric cancer. Plans were evaluated by two different radiation oncologists with disagreements being resolved by a third oncologist. Two-year overall survival rates in this study were improved, but not of statistical significance (65 vs 51%; p = 0. However, they did not detect any difference in radiation dose to the kidney, spinal cord and liver. The authors estimate that this will lead to a near doubling of the second malignancy rate from 1% for conventional radiotherapy to 1. It can be argued that due to the poor long-term survival of gastric cancer patients, second malignancies arising after a period of 10 years may not be clinically relevant. These authors also reported no adverse events greater than grade 2 in either treatment group. Targets usually treated with this technique are small, approximately 6 cm or less, so this technique could not be applied to standard postoperative radiation fields that treat draining lymph node basins, anastomotic sites and preoperative tumor volumes. However, given the very low involvement of organs at risk with all three modalities, it remains to be seen whether or not such reduction in healthy tissue irradiation will confer a clinical benefit. Para-aortic lymph node recurrence of gastric cancer poses an important therapeutic challenge from a radiotherapy perspective in that the proximity of these lymph nodes to critical structures, such as the spinal cord, small intestine and colon, hinder the delivery of effective doses of radiation with standard regimens [149].
Participants must have had either limited or no prior exposure to bone modifying agents and a clinical care plan that included use of Zol within 30 days of registration medications that cause high blood pressure purchase chloromycetin 500 mg on-line. Cancer treatments symptoms 6 months pregnant 250mg chloromycetin for sale, bone modifying agents (including Zol) symptoms pancreatic cancer purchase chloromycetin 250 mg amex, and dental care were administered as clinically indicated and were not directed by S0702 treatment chlamydia discount chloromycetin 500mg overnight delivery. Results: the study enrolled 3,491 evaluable pts (breast 1,120; myeloma 580; prostate 702, lung 666, other 423) between 2009-2013. Guidelines suggest that a dose of 5 mg should be taken into consideration in patients at risk of sedation. However, sedation associated with recommended doses of olanzapine precludes its wide use in oncology practice. Primary endpoint was complete nausea control (no nausea and no rescue medication) 0-120 hours after chemotherapy. Complete response (no emesis and no rescue medication) was a key secondary end point. The groups were well balanced, median age was 49 years, vast majority of patients (95. Effects of exercise on cancer-related fatigue and muscular strength in patients with breast cancer. Results from this study provide further evidence of the benefits of exercise for supportive cancer care. First Author: Jaime Feliu Batlle, Medical Oncology Department, La Paz University Hospital, Madrid, Spain Background: Older patients have increased risk of toxicity from chemotherapy. The purpose of this study was to analyse predictive factors for developing grade 3-5 toxicity in older patients treated with chemotherapy. Methods: this prospective multicenter study included 500 cancer patients $ 70 years between Feb 2014 and Jun 2018. A prechemotherapy assessment including sociodemographics, tumor/treatment variables, laboratory test results, and geriatric assessment variables (function, comorbidity, cognition, psychological state, social activity/support, and nutritional status) was performed. Logistic regression was used to examine the association between these factors and the development of grade 3-5 toxicity. Conclusions: Renal function and chemotherapy dose were significant predictors of grade 3-5 toxicity among older patients treated with chemotherapy. In the first 12 months after trial registration, patients with diabetes ($38,324 vs $30,923, 23. Being able to predict toxicity risk for different treatments in older adults can aid treatment decision-making and supportive care. Methods: Men age 65+ were enrolled in this prospective observational study at 3 academic centres, Princess Margaret Cancer Centre, Sunnybrook Health Sciences Centre, and Kingston Health Sciences Centre in Ontario, Canada. Lab abnormalities were documented only if resulting in emergency room visits, requiring treatment, or affecting subsequent oncologic treatment. Toxicity was rated using the Common Terminology Criteria for Adverse Events version 4. Results: 643 patients underwent major cancer surgery with curative(94%) or palliative (6%) intent (February 2017-September 2018). The study will allow clinicians to associate clinical outcomes with individual factors of the preoperative assessment and create a user-friendly tool to predict outcomes that matter to patients. Methods: A retrospective review of a prospectively maintained database was performed on patients over 75 years old who underwent elective surgery with hospital length of stay of $1 day at Memorial Sloan Kettering Cancer Center from 2015-2018. We utilized a multivariable logistic regression model with 90-day mortality as the outcome, geriatric comanagement as the predictor, and adjusted for age, gender, American Society of Anesthesiology score, Memorial Sloan Kettering Frailty Index, preoperative albumin level, operation time, and estimated blood loss. The same logistic model was used to assess the association between adverse surgical events within 30-days (any major complication, readmission, or urgent care center visit) and geriatric comanagement. Results: Of 1,855 patients (median age 80), 1,009 patients (54%) were co-managed by geriatricians. Conclusions: Our study shows that geriatric comanagement is associated with reduced 90-day postoperative mortality in cancer patients aged $75. Methods: We conducted a single-site randomized clinical trial of a hospice video decision aid versus a verbal description in 150 hospitalized patients with advanced cancer and their caregivers. Intervention participants (75 patients; 18 caregivers) received a verbal description about hospice plus a six-minute video depicting hospice care. Control participants (75 patients; 26 caregivers) received only the verbal description. The primary endpoint was patient preference for hospice care immediately after the intervention, adjusting for baseline preferences. Secondary outcomes included patient and caregiver knowledge and perceptions of hospice (Hospice Perception and Knowledge Questionnaire). Post-intervention, caregivers assigned to the video were more likely to prefer hospice care for their loved ones (94. Conclusions: Patients with advanced cancer and their caregivers who viewed a hospice video decision support tool were more informed about hospice care and reported more favorable perceptions of hospice. Future work should examine the impact of the video on hospice utilization and length-of-stay among patients with advanced cancer. We used repeated measures mixed modeling to assess change in outcome measures over time. Conclusions: To our knowledge, this is the first mobile app to utilize patient reported outcomes and artificial intelligence to significantly decrease pain scores and pain-related hospitalizations in patients with cancerrelated pain. For each domain, we limited the study group to those with zero baseline fatigue and defined severe fatigue change as score increase above the third quartile. We aimed to develop new predictive algorithms based on machine learning to refine individualized prognosis in older patients with cancer. Results: During the 1-year study period, 875 (43%) and 219 (16%) patients died in the training and validation sets, respectively (mean age: 8166 / 7865, women 47% / 70%, metastasis 50% / 34%). Cox model identified 9 independent predictors of mortality: tumor site/metastatic status, anticancer treatment, weight loss. The latter model has been implemented into an interactive web interface for easy and direct use in clinical practice. The potential impact of cancer, its treatment or the lasting effects on daily mental and physical tasks are not fully understood. Methods: Eligibility included diagnosis of malignancy between ages 18-39, 1-5 years from diagnosis and $1 year from therapy completion. Participants were randomly selected from tumor registries of 7 academic institutions. All enrolled subjects had diagnostic and treatment information abstracted by a standardized protocol and entered into a database. Cognitive rehabilitation program to improve cognition of cancer patients treated with chemotherapy: A randomized controlled multicenter trial. Results: 167 patients were enrolled, median age was 50 years [43-59] and 96% were women with mainly breast cancer. Patients in group A presented improvement in depression compared to group B and C: -6. All outcomes were evaluated at baseline, Week 8 (end of intervention), and Week 20 (12 weeks post-intervention). Further investigation of these two therapies may lead to effective and personalized interventions for cancer survivors. In this secondary analysis, we assessed whether specific recommendations to oncologists to discuss patient goals, proxy and advance directives resulted in increased communication about these topics. Methods: Patients aged 70+ with advanced solid tumors or lymphoma and at least one impaired geriatric domain. Oncology practices were randomized to the intervention (oncologists received recommendations to elicit goals and discuss wishes) or usual care. The clinic visit after the oncologist received recommendations was recorded and transcribed; two blinded coders evaluated the transcripts for discussion of the specific topic areas recommended in the intervention. Between arm differences were compared using generalized linear models controlling for practice cluster. Results: From 2014-17, 528 patients (284 intervention) provided transcripts from 31 practices (mean age = 77, range 70-96 years; 49% female; mixed cancer diagnoses). Topics related to patient goals, proxy and advance directive wishes were more often discussed in the intervention arm (goals of care preferences: 9 vs 2%, p =. Conclusions: In this community-based study of older adults providing recommendations to oncologists to discuss specific topics resulted in increased person-centered discussions with patients and caregivers about goals, proxy and advance directive wishes. Few studies have evaluated prognostic understanding in patients with hematologic malignancies.
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