Tamoxifen in breast cancer survivors with COVID 19: stop or go?

The COVID 19 pandemic threatens human health in many ways. Although vaccines that have completed phase 3 trials are being used today, it is estimated that the risk of infection will continue for a whil

Merkezimizde Renal Transplantasyon Tanısı İle Takip Edilen Hastalarda Sitomegalovirüs Enfeksiyonu İçin Profilaksi/Preemptif Yöntemlerinin Karşılaştırılması

Doku ve organ nakillerinde etkili bir immunosüpresyon yapılmazsa doku reddi sorunu karşımıza çıkmaktadır. Etkili immunosüpresyon da fırsatçı enfeksiyonların görülmesine neden olmaktadır. Bu fırsatçı enfeksiyonlardan biri CMV dir. CMV enfeksiyonu veya reaktivasyonu SOT alıcılarında % 75 lere varan oranda görülebilmektedir. CMV enfeksiyonun allogreft üzerinde direk ve indirek etkileri olduğu bilinmektedir. Bu nedenle genel olarak SOT hastalarından CMV enfeksiyonu açısından yüksek ve orta risk grubunda bulunanlara, profilaktik tedavi uygulanmaktaydı. Yıllar içinde CMV viral replikasyonunu hızlı ve doğru bir şekilde ortaya koyan CMV PCR tanı yönteminin kullanılmaya başlanmasıyla, preemptif izlem yöntemi gündeme gelmiştir. Çalışmamızda CMV yönetim stratejilerinden preemptif izlemin, en az profilaktik tedavi yöntemi kadar etkili olduğunu ortaya koymak ve maliyet etkinlik açısından daha uygun olduğunu göstermek amaçlanmıştır. Bu çalışmada 01.01.2010 ile 01.01.2015 tarihleri arasında Gazi Üniversitesi Tıp Fakültesi Hastanesi Nefroloji bölümünde böbrek nakli tanısıyla takip ve tedavi edilen hastalar, CMV yönetim stratejileri, CMV enfeksiyonu ve bunun böbrek fonksiyonu üzerine etkisi açısından geriye dönük olarak değerlendirilmiştir. Hastalar preemptif izlenenler ve profilaktik tedavi alanlar olarak iki ayrı grupta değerlendirilmiştir. Bu iki gruptaki hastaların dosya ve bilgisayar kayıtlarından demografik özellikleri, KBY nedenleri, hemodiyaliz ve/veya periton diyalizi uygulamaları, almış oldukları immunosüpresif tedavileri,CMV IgG, IgM , CMV PCR, BUN, Kreatinin, GFR değerlendirmesi ve ortalama maliyetler araştırılmıştır. Preemptif izlenen 28 hastanın 2 sinde, profilaktik tedavi alan 43 hastanın 7 sinde CMV enfeksiyonu oluşmuş olup, iki grup arasında CMV enfeksiyonu oluşumu açısından istatistiksel olarak anlamlı fark bulunmamıştır (p=0,467). CMV enfeksiyonu gelişen tüm hastaların, CMV enfeksiyonu öncesi BUN, Kreatinin ve GFR ortalama değerleri sırasıyla 29,89(±16,34)mg/dL, 1,61(±0,85) mg/dL, 48,72(±28,23)mL/dk/1,73m² iken; enfeksiyon sonrası BUN, Kreatinin ve GFR ortalama değerleri sırasıyla 35,77(±15,90)mg/dL, 1,80(±0,91)mg/dL, 47,11(±23,73)mL/dk/1,73m² olarak hesaplanmıştır. CMV enfeksiyonu öncesi/sonrası BUN, Kreatinin, GFR ortalama değerleri arasında istatistiksel olarak anlamlı fark tespit edilmemiştir (sırasıyla p=0,260/p=0,202/0,680). Benzer şekilde preemptif izlem ve profilaktik tedavi gruplarında da CMV enfeksiyonu öncesi/sonrası BUN, Kreatinin, GFR ortalama değerleri karşılaştırıldığında istatistiksel olarak anlamlı fark tespit edilmemiştir (preemptif izlenen grup için sırasıyla p=0,381/0,473/0,258, profilaktik tedavi alan grup için sırasıyla p=0,566/0,658/0,779) Preemptif izlenen hastaların aylık ortalama tedavi maliyeti 91,18(±33,10) TL, profilaktik tedavi alan hastaların ise 64,45(±25,43) TL olarak hesaplanmıştır. Preemptif izlenen hastaların aylık ortalama maliyeti, profilaktik tedavi alanlara göre istatistiksel olarak anlamlı biçimde düşük bulunmuştur (p=0,017) Çalışmamız preemptif izlem yönteminin en az profilaktik tedavi yöntemi kadar etkin ve maliyet açısından daha avantajlı olduğunu göstermiştir.Allograft rejection is one of the major problems of solid organ transplantation which need effective immunosuppression. Effective immunosuppression increases the occurrence of opportunistic infections. CMV infection is one of them. CMV infections or reactivations occur approximately 75 % of SOT recipients. It is well known that CMV infection has direct or indirect effects on the allografts. Therefore prophylactic therapy was recommended to SOT recipients who are in the high or intermediate risk group for the CMV infection. After the using of CMV PCR technique, which shows viral replications correctly and rapidly, preemptive therapy becomes an alternative strategy to prophylactic therapy. The aim of the study was comparing the effectiveness of preemptive screening and preemptive therapy as well as cost effectiveness. In this study, renal transplant recipients who were followed in Nephrology Department at Gazi University School of Medicine between January 1st, 2010 - January 1st, 2015 are evaluated retrospectively. Patients are divided into two groups as preemptive screening and prophylactic therapy. End-stage renal disease etiology, pre-transplantation treatment modality, immunosuppressive drugs, CMV IgG and IgM, CMV PCR, BUN, plasma creatinine levels and GFR values were obtained for all patients. The association between CMV infection, renal functions and pre-transplantation treatment modality was investigated retrospectively. CMV infection occurred 2 of 28 patients in preemptive screening group, 7 of 43 patients in prophylactic therapy group. There was no statistically significant difference between two groups for CMV infection occurrence (p=0,467). Mean value of BUN, Creatinine and GFR were consecutively 29,89(±16,34)mg/dL, 1,61(±0,85)mg/dL, 48,72(±28,23) mL/dk/1,73 m² before CMV infection. After CMV infection, mean value of BUN, Creatinine and GFR were measured as consecutively 35,77(±15,90)mg/dL, 1,80(±0,91)mg/dL, 47,11(±23,73) mL/dk/1,73 m² in all patients. There was no statistically significant differance for mean value of BUN, Creatinine, GFR between before and after CMV infection (consecutively p=0,260/0,202/0,680). Similarly there was no statistically significant differance for mean value of BUN, Creatinine, GFR between before and after CMV infection in preemptive screening and prophylactic therapy groups (in preemptive screening group consecutively p=0,381/0,473/0,258, in prophylactic therapy group p=0,566/0,658/0,779). Average monthly cost of each patient in preemptive screening and prophylactic therapy groups were consecutively 91,18(±33,10)/ 64,45(±25,43) TL. Average monthly cost of each patient in preemptive screening group is lower than each patient in prophylactic therapy group (p=0,017) In conclusion, our study shows that preemptive screening is effective as much as prophylactic therapy, and preemptive screening has lower cost than prophylactic therapy does

Is it safe to use long-acting G-CSF for febrile neutropenia prophylaxis in COVID-19 pandemic?

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Impact of coronaphobia on treatment and follow-up compliance of cancer patients

The aim of this study was to assess the impact of coronaphobia on treatment and follow-up compliance in cancer patients. The records of 230 cancer patients were reviewed. Coronaphobia was assessed via the validated COVID-19 Phobia Scale (C19P-S). A total of 64% of the patients had a high coronaphobia score. Among them, 59% were noncompliant. In multivariate logistic regression analysis, low educational status, treatment type, following COVID-19 news, having knowledge about COVID-19 transmission and higher C19P-S score were associated with noncompliance (p = 0.006, p < 0.001, p = 0.002, p = 0.002 and p = 0.001, respectively). Multivariate analysis revealed that having knowledge about COVID-19 transmission was related to a higher C19P-S score (p = 0.001). The cancer patients studied had significant coronaphobia. Moreover, greater coronaphobia was significantly associated with noncompliance with follow-up and treatment

Determining the current situation of geriatric oncology in Turkey: A survey of medical oncologists

Objective: We aimed to capture a snapshot of the current situation in Turkey regarding the management of elderly cancer patients through an online survey of medical oncologists in Turkey. Material and Methods: An anonymized cross-sectional nationwide de-scriptive online survey was sent to the Turkish Society of Medical Oncology members by email in November 2020. Before closing the survey in December 2020, one remainder was sent. Results: The survey was completed by 133 medical oncologists from 41 centers with a 29% response rate. Routine use of geriatric evaluation was practiced by 18.2% of the medical oncologists in their daily practice. A geriatrician was available in the centers of 36.8% of the participants. The Eastern Cooperative Oncology Group performance status was the most commonly employed tool for investigating older cancer patients. Our survey determined that the presence of malnutrition, treatment adherence, comor-bidities, and social support were the most commonly identified challenges while caring for geriatric cancer patients. Hearing problem was the most common reason, followed by dementia, regarding the communication with the elderly cancer patients. Conclusion: Our survey results revealed a very low rate of geriatric evaluation for systemic treatment planning in elderly patients. Moreover, medical oncologists encoun-tered a high rate of communication problems and additional challenges in the care of geriatric cancer patients. These findings signify the need for geriatrics and oncology collaboration for the optimization of geriatric cancer care

Factors affecting survival in retroperitoneal sarcomas treated with upfront surgery: A real-world study by Turkish Oncology Group

Retroperitoneal sarcomas (RPS) account for approximately 15% of all soft tissue sarcomas (STS) and encompass a heterogeneous group of tumors with limited multimodality treatment options. Surgical resection with negative margins remains the standard primary treatment for patients with localized RPS. In this multicenter study, we aimed to demonstrate the real-world data on factors affecting survival in RPS treated with upfront surgery. We included a total of 197 patients who underwent curative-intent resection of a primary non-metastatic RPS between 2000-2020 at ten experienced medical oncology departments in Turkey. The median follow-up was 33 months. The median age of patients was 53 years, 57.4% of patients were female. Univariate analysis revealed that; tumor size, grade, necrosis, resection margin status, were factors affecting recurrence-free survival (RFS) (p= 0.002, p= 0.044, p= 0,024, p= 0.003 respectively). Age, tumor size, stage, resection margin status were factors affecting overall survival (OS) (p= 0.038, p= 0.001, p= 0.032, p< 0.001, respectively). In multivariate analysis, tumor size and resection margin status were independent factors affecting RFS and OS (all p-values < 0.05). Our study demonstrated that tumor size, and resection margin status were the main factors affecting survival in resected RFS. In comparison, adjuvant chemotherapy (CT), radiotherapy (RT), or multimodality treatment did not show OS and RFS advantages. We believe that advances in the molecular characterization of these tumors might help clinicians to detect the best candidates for adjuvant therapies in RPS

Immunogenicity and safety of the CoronaVac vaccine in patients with cancer receiving active systemic therapy

Aim: To evaluate the immunogenicity and safety of the CoronaVac vaccine in patients with cancer receiving active systemic therapy. Methods: This multicenter, prospective, observational study was conducted with 47 patients receiving active systemic therapy for cancer. CoronaVac was administered as two doses (3 mu g/day) on days 0 and 28. Antibody level higher than 1 IU/ml was defined as 'immunogenicity.' Results: The immunogenicity rate was 63.8% (30/47) in the entire patient group, 59.5% (25/42) in those receiving at least one cytotoxic drug and 100% (five of five) in those receiving monoclonal antibody or immunotherapy alone. Age was an independent predictive factor for immunogenicity (odds ratio: 0.830; p = 0.043). Conclusion: More than half of cancer patients receiving active systemic therapy developed immunogenicity. Tweetable abstract Immunogenicity developed with CoronaVac in 25 (59.5%) of 42 patients who received at least one cytotoxic drug and in all patients (n = 5) who received monoclonal antibody or immunotherapy alone