Application and Benefits of Web-Mediated Symptom Reporting for Patients Undergoing Immunotherapy: A Clinical Example

International audienceTwo randomized studies of symptom monitoring during chemotherapy or during second line treatment and follow-up via web-based patient-reported outcomes (PROs) was previously demonstrated to lengthen survival. We are presenting here a patient with advanced and recurrent lung cancer who was followed for 4 years by PROs for relapse and adverse events detection. We report how the web-mediated follow-up helped to detect dangerous pulmonary embolism, relapse and pseudo-progression to immunotherapy by self-reported symptom tracking and specific algorithms triggering notifications to medical team, allowing early management of events. We particularly describe how a discordance between objective clinical improvement under immunotherapy assessed by the application allowed to detect pseudo-progression on imaging and allowed maintenance of the treatment during more than 1-year, although imaging report could have led to stop an effective therapy. The progression observed in the routine imaging was indeed in clear contradiction with improvements in patient's global status as assessed by the reduced PRO-score computed from patient self-reported symptoms. The ability of e-health tools based on symptoms reporting for tumor response assessment should be assessed in trials to help physician in decision of stopping or continuing therapy

Racial Differences in Adipose Tissue Distribution and Risk of Aggressive Prostate Cancer among Men Undergoing Radiotherapy

BACKGROUND: While elevated body mass index (BMI) has been associated with increased risk of aggressive prostate cancer (PC), the importance of adipose tissue distribution is not well understood. We examined associations between overall and visceral obesity and aggressive PC risk. Moreover, given racial differences in adipose tissue distribution, we examined whether race modified these associations. METHODS: We conducted a cross-sectional analysis of 308 radiation-treated PC patients within the Durham VA from 2005–2011. Multivariable logistic regression examined the association between BMI categories and tertiles of waist circumference (WC), visceral fat area (VFA) and periprostatic adipose tissue area (PPAT) with high-grade PC risk (Gleason score ≥7 vs. ≤6). Models stratified by race examined whether these associations differed between black and non-black men. RESULTS: Both elevated BMI (p-trend=0.054) and WC (p-trend=0.040) were associated with increased high-grade PC risk, with similar results between races, although the association with BMI was not statistically significant. In contrast, elevated VFA was associated with increased aggressive PC risk in black men (p-trend=0.002) but not non-black men (p-trend=0.831), with a significant interaction between race and VFA (p-interaction=0.035). Though similar patterns were observed for PPAT, none were statistically significant. CONCLUSIONS: Among men undergoing radiation therapy for PC, visceral obesity is associated with increased aggressive PC risk, particularly among black men. If confirmed in future studies, these results suggest adipose tissue distribution differences may contribute to PC racial disparity. IMPACT: These findings highlight the need to elucidate mechanisms contributing to racial differences in the association between visceral obesity and aggressive PC

Combined-modality therapy versus radiotherapy alone for treatment of early-stage Hodgkin\u27s disease: cure balanced against complications.

PURPOSE: The treatment of early-stage Hodgkin\u27s disease (HD) has evolved from radiotherapy alone (RT) to combined-modality therapy (CMT) because of concerns about late adverse effects from high-dose subtotal nodal irradiation (STNI). However, there is little information regarding the long-term results of CMT programs that substantially reduce the dose and extent of radiation. In addition, lowering the total radiation dose may reduce the complication rate without compromising cure. This retrospective study compares the long-term results of STNI with CMT using modestly reduced RT dose in the treatment of early-stage HD. PATIENTS AND METHODS: Between 1982 and 2002, 111 patients with stage IA and IIA HD were treated definitively with RT (mean dose, 37.9 Gy); 70 patients were treated with CMT with low-dose involved-field radiotherapy (LDIFRT; mean dose, 25.5 Gy). Median follow-up was 11.7 years for RT patients and 8.1 years for the CMT group. RESULTS: There was a trend toward improved 20-year overall survival with CMT (83% v 70%; P = .405). No second cancers were observed in the CMT group; in the RT group the actuarial frequency of a second cancer was 16% at 20 years. There was no difference in the frequency of cardiac complications (9% v 6%, RT v CMT). CONCLUSION: In this retrospective review, CMT with LDIFRT was effective in curing early-stage HD and was not associated with an increase in second malignancies. For RT alone, a moderate dose seemed to reduce cardiac complications but did not lessen second malignancies compared with higher doses used historically