The most-cited articles in geriatric oncology: A bibliometric analysis

Introduction: We conducted a bibliometric analysis to determine the most impactful articles in the oncologic management of elderly cancer patients. Material and methods: We searched Web of Science papers with six keywords: “geriat*” OR “older patient*” OR “older adult*” OR “elderly” and “*cancer” OR “oncolog*”. We identified and analyzed the top 100 most-cited articles and abstracted information on topic, journal, first author, year, institution, level of evidence, and the adjusted citation index. Results: Of the 100 most-cited papers, 62 had at least one author from the United States of America. Of the 62 United States papers, 18 had at least one author from Harvard University and 14 had authors from the National Institutes of Health. Among the 50 authors who contributed to the most-cited papers, Hurria is the most prolific author, with nine papers. Lung, breast, and colorectal cancers are the most studied cancer types, and the Geriatric 8 scale is the most studied scale. Conclusions: Our study is the first to analyze the top 100 most-cited studies in geriatric oncology. By comprehensively identifying the authors, institutes, journals, and the levels of evidence of these studies, we have created an easily accessible resource for practicing physicians to reference within this important area of oncology. © 2021 Termedia Publishing House Ltd.. All rights reserved

Ratlarda siklofosfamid ile indüklenen hemorajik sistitisde glycyrrhizinin koruyucu etkilerinin patolojik olarak incelenmesi

Cyclophosphamide (CP) is a widely used anti-neoplastic agent in humans and small animals and also has some adverse effects in them. The most common adverse effect of CP is hemorrhagic cystitis (HS). The use of Mesna may prevent HS, but is insufficient for some side effects. In this study, the effect of glycyrrhizin (GLY), which is one of the active substances of licorice root, was examined against CP-related side effects. The experiment was designed with 49 male Sprague Dawley rats. The Control group received only physiological saline and the CP group only CP. CP+Mesna group received CP and also three dose of Mesna. The animals in the CP+GLY100 and CP+GLY200 groups were received three doses of GLY, 100 mg/kg and 200 mg/kg dose, respectively. The previous protocol was applied to the CP+Mesna+GLY100 and CP+Mesna+GLY200 groups and only the first GLY application was replaced with Mesna. In this study, it was recorded that bladder macroscopy and histopathology were better preserved in GLY applicated groups compared to CP group. However, it was observed that this protection was slightly weaker than the Mesna and GLY-Mesna combinations. From this point of view, it was observed that GLY could be preventive in CP-related HS, in addition it could also support to Mesna applications.Siklofosfamid (CP) yaygın olarak kullanılan bir anti-neoplastik ajandır ve bazı yan etkilere sahiptir. Siklofosfamidin en belirgin yan etkisi hemorajik sistitistir (HS). Mesna kullanımı HS’yi önleyebilmekte ancak diğer bazı yan etkiler için yetersiz kalmaktadır. Bu çalışmada, CP ilişkili HS’ye karşı, meyan kökünün aktif içeriklerinden olan glycyrrhizinin (GLY) etkisi incelenmiştir. Çalışma, 49 adet, erkek Sprague Dawley rat ile dizayn edilmiştir. Kontrol grubuna sadece fizyolojik tuzlu su, CP grubuna ise sadece CP verilmiştir. CP+Mesna grubuna CP ve ayrıca 3 doz Mesna uygulanmıştır. CP+GLY100 ve CP+GLY200 gruplarına; CP ve sırasıyla 100 mg/kg ile 200 mg/kg olmak üzere üç doz GLY uygulanmıştır. Bir önceki protokol CP+Mesna+GLY100 ve CP+Mesna+GLY200 gruplarınada uygulanmış olup sadece ilk GLY uygulaması Mesna ile değiştirilmiştir. Çalışmada GLY uygulanan gruplarda CP grubuna kıyasla mesane makroskobisi ve histopatolojisinin daha iyi bir şekilde korunmuş olduğu kaydedilmiştir. Ancak, bu korumanın Mesna ve GLY-Mesna kombinasyonlarına kıyasla biraz daha zayıf kaldığı izlenmiştir. Buradan yola çıkılarak GLY’in CP ilişkili HS’de önleyici olabileceği aynı zamanda Mesna uygulamalarına destek verebileceği kanaatine varılmıştır

Urgent approach to a patient presenting with type A aortic dissection associated with cardiac tamponade

Altmış sekiz yaşındaki erkek hasta ani başlayan göğüs ve sırt ağrısını takiben gelişen, geçici bilinç kaybı ile acil polikliniğimize başvurdu. Fizik bakıda baş ve boyun bölgesinde belirgin siyanoz, boyun ven distansiyonu bulunan hastanın ekokardiyografisinde kalp boşlukları çevresinde yoğun içerikli sıvı görüldü. Kontrastlı torakoabdominal bilgisayarlı tomografide diseksiyon lehine bulgu saptanamadı. Perikardiyal tüp drenajı ile 650 cc sıvı boşaltılan hastanın klinik durumu belirgin olarak düzeldi. Tekrarlanan ekokardiyografide çıkan aortta, kapak seviyesinden 2 cm proksimalde başlayan hipodens alanın ayırdığı çift kontur görünümü saptandı. Hasta ameliyata alındı, çıkan aorta kapak seviyesinden 2 cm proksimalden itibaren 6 cm'lik segment boyunca Dacron greft yerleştirildi ve şifa ile taburcu edildi.A male patient aged 68 years, arrived to the emergencyoutpatient clinic with a transient loss of conscience, following acute onset chest and back pain. Physical examination of the patient revealed cyanosis in the head and neck region and distension of neck veins. A dense effusion around the cardiac spaces was observed during the echocardiographic examination. Thoracoabdominal computed tomography with contrast did not reveal findings supporting dissection. The clinical condition of the patient improved significantly after the drainage of 650 ml of fluid. On repeat echocardiography, a double contour in the ascending aorta, 2 cm proximal to the valvular level and separated by a hypodense area was observed. The patient was operated and a Dacron graft was inserted to the ascending aorta along the 6 cm segment starting from 2 cm proximal to the valvular level. The patient was discharged upon full recovery

Comprehensive Analysis of Prognostic Factors in Advanced Gastric Cancer Patients Treated with Chemotherapy

Objective: To evaluate the strongest prognostic factors in advanced gastric cancer. Study Design: Observational study. Place and Duration of Study: Department of Medical Oncology, Tekirdag Namik Kemal University, Tekirdag, Turkey, between March 2012 and April 2022. Methodology: Adult patients with metastatic cancer who had completed at least two months of chemotherapy, without any other comorbidity were included. Using Kaplan-Meier methodology and Cox regression methods, potential prognostic factors were analysed for overall survival. Two different models were created for multivariate analysis by using statistically significant factors in univariate analysis. Results: The median overall survival in 216 patients was 7.8 months. The univariate analysis showed that body-mass index, performance status, liver metastasis, albumin, gamma-glutamyl transferase, carcinoembryonic antigen, carbohydrate antigen (CA 19-9), neutrophil-lymphocyte ratio (NLR), systemic immune-inflammation index, albumin-to-alkaline phosphatase ratio, sodium-globulin ratio (SGR) prognostic nutritional index (PNI), albumin-bilirubin ratio, and albumin-globulin ratio were associated with survival. In Model 1, which included only laboratory indices, multivariate analyses revealed that NLR (p= 0.001), SGR (p=0.025), and PNI (p=0.032) were prognostic for overall survival. In Model 2, established with all parameters, NLR (p=0.003), albumin (p=0.003), performance status (p<0.001), and CA 19-9 (p<0.001) were found to be independent prognostic factors. Conclusion: Pretreatment NLR, SGR, PNI, albumin, performance status, and CA 19-9 are strong prognostic factors in patients with advanced gastric cancer. These prognostic factors, which are easily accessible in clinical practice, may be utilised as useful tools for clinicians

Use of Complementary Therapy in Lung Cancer Patients Treated with Chemotherapy and its Effect on Survival: A Cross-sectional Study

Aim: Complementary therapies are being increasingly preferred in patients receiving anticancer therapy to strengthen the effect of chemotherapy and control cancer-related symptoms. In this study, we investigated the prevalence of complementary therapy (CT), the factors associated with its use, physician-patient information sharing about CT use, and the effect of CT on the survival and treatment process in lung cancer patients receiving chemotherapy. Methods: This study was designed as a cross-sectional study including patients who underwent chemotherapy for lung cancer between November 2020 and March 2022 in the department of medical oncology at Tekirdag Namik Kemal University. A structured questionnaire with twenty questions was used. Fluor-18-fluorodeoxyglucose positron emission tomography/CT, and brain magnetic resonance imaging were used to stage the patients. The stages were grouped as early (stages 1B-3A) and advanced (stages 3B-4A). Results: A total of 242 patients included in the study. One hundred and forty-seven (60.7%) patients reported using at least one type of CT since the first diagnosis. “Families/relatives” (n=128; 63.7%) and “other patients” (n=67; 33.3%) were the primary sources from which patients obtained CT information. The most widely used CT methods were recorded as phytotherapy (79.6%) and apitherapy (59.2%). 125 (85%) of the patients said that they used CT to support their existing anticancer treatments. Of the patients using CT, 94 (63.9%) stated that they did not disclose their use of CT to their physicians. The majority of patients stated that their physicians did not inquire about using CT. In the cox regression analysis performed to determine survival benefit, no survival benefit from the use of CT was determined (hazard ratio=0.86, p=0.495). In the subgroup analysis, the use of CT was associated with survival in early-stage patients, but no survival relationship was found in advanced-stage patients (log-rank p=0.027 and p=0.842, respectively). Conclusion: The use of CT in conjunction with medical treatment is common among patients with lung cancer. The influence of the oncologist in guiding the use of CT in cancer patients is weak. Additionally, the use of CT does not provide benefits in terms of survival. © 2023 by The Medical Bulletin of Istanbul Haseki Training and Research Hospital The Medical Bulletin of Haseki published by Galenos Yayinevi

Understanding Breast Cancer From the Patients' Perspective

Objectives: We performed this study to seek what patients think about their diagnosis, treatment process and survi vorship. Methods: We evalued 125 breast cancer patients receiving chemotherapy in a descriptive and prospective study using a well-structured questionnaire. Results: Most of the patients had information about breast cancer screening at the time of the questionnaire (57.6%), but the proportion of those who had prior knowledge of the disease was low (29.6%). While the most frequent sign of breast cancer was reported to be a palpable mass (53.6%), the most frequent detection method was breast self examination (67.2%). The most frequent adverse effect of chemotherapy were reported to be hair loss (98.4%). Patients’ expectations regarding the disease and adverse events were mostly stated as “I will be completely cured” (79.2% and 53.6%, respectively). Etiological factor most frequently accepted by the patients were stress (85.6%). Most of the pa tients received support from their families during the course of the disease (91.2%). Conclusion: This study provides important new information for every stage of the fight against breast cancer from the perspective of cancer patients. These findings are useful for new programs and clinical decision-making

The influence of visual objects and music on anxiety levels of breast cancer patients scheduled to experience chemotherapy for the first time: a prospective randomized clinical study

Objective: To investigate the influence of music together with visual objects as an ambiance in the waiting room on anxiety levels of breast cancer patients scheduled to receive chemotherapy in outpatient setting for the first time. Material and method: Breast cancer patients planned to receive adjuvant or neoadjuvant chemotherapy for the first time between November 1, 2020, and July 31, 2021, were included. Two designs, including a standard waiting room (StWR) and an intervention waiting room (IWR) that was created by adding music and visual objects to the standard room, were constructed. These 2 designs were repeated sequentially in monthly periods, and a total of 104 patients with 52 in each group were randomized. The State Trait Anxiety Inventory (STAI) and Hospital Anxiety and Depression Scale (HADs) were used for assessments. Results of the patients in StWR and IWR groups were compared. Results: Both HADs anxiety and STAI-state anxiety scale scores were lower in patients who waited in IWR compared to those who waited in StWR (p = 0.041, p = 0.012, respectively). In patients in the IWR group, mean heart rate was lower by 7.6 bpm (p = 0.009). No difference was found between the groups with regard to HADs depression score and STAI-trait anxiety score (p = 0.305, p = 0.535, respectively). For all patients, HADs anxiety scale (r = 0.400, p = < 0.001) and STAI-state anxiety scale (r = 0.475, p = < 0.001) scores increased as the waiting time increased. Discussion and conclusion: The present study is the first to investigate the influence of adding music together with visual objects to the standard ambiance of the chemotherapy waiting room on anxiety levels of breast cancer patients. We propose that introduction of paintings, artificial plants, and music to the ambiance of the waiting room has a significantly positive effect on alleviating anxiety levels of cancer patients waiting for chemotherapy. © 2021, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.The funding was supported by the authors themselves without the involvement of grants, research scholarships, or any other funding sources

Prognostic Role of Lymphovascular Invasion and Perineural Invasion in Breast Cancer Treated with Neoadjuvant Chemotherapy

In our study, we investigated the predictive properties of LVI (lymphovascular invasion) and PNI (perineural invasion) on survival times from pathology specimens obtained from surgical operation after neoadjuvant chemotherapy (NAC) with breast cancer patients. Two hundered eleven female patients were included in this study. We evaluated the relationship between potential prognostic factors and mean recurrence-free survival (RFS) and overall survival (OS) times using Kaplan-Meier methodology and Cox proportional hazard modelling.The mean follow-up time was 27.3 months.PNI positive patients had shorter RFS and OS times than PNI negatives (p< 0.001, p= 0.002, respectively), and LVI positive patients had shorter RFS and OS times than LVI negatives (p< 0.001, p< 0.001, re-spectively). In the multivariate analysis performed, the presence of pN stage and PNI were found to be predictive for RFS (p= 0.047, p< 0.001, respectively), while pT stage and PNI positivity were found to be predictive for OS (p= 0.035, p= 0.017, respectively). LVI did not show the property of being an independent predictive marker for survival. PNI caused significant survival differences in all subtypes for both RFS (log-rank p< 0.001, p= 0.003, p= 0.001, respectively) and OS(log-rank p= 0.035, p= 0.006, p= 0.020 respectively) in HR+/Her2-, Her2+ and Triple negative breast cancer subtyping. LVI, on the other hand, caused survival distribution difference for RFS (p= 0.021) in the HR+/Her2-subtype and for both RFS and OS in the Triple-negative subtype (p< 0.001, p= 0.025, respectively). PNI is strongly and significantly associated with RFS and OS. We suggest that it can be used in identifying high-risk patients for recurrence of PNI and in new staging systems

Immunogenicity and safety of the CoronaVac vaccine in patients undergoing treatment for breast and lung cancer

BACKGROUND: Patients with cancer receiving an active systemic therapy are at a high risk for coronavirus disease (COVID-19); however, the antibody response and long-term results of the inactivated whole-virion SARS-CoV-2 (CoronaVac) vaccine in these patients compared to the non-cancer population are unknown. OBJECTIVE: To compare seroconversion for SARS-CoV-2 receptor-binding domain (RBD) specific IgG positivity against two doses of the CoronaVac vaccine in breast and lung cancer patients receiving systemic therapy, to determine the factors affecting seropositivity, and to observe long-term results up to a secondary booster vaccine. RESULTS: The analysis included 201 cancer patients (99 breasts, 102 lungs; median age: 59 years (range: 28-92), 42.3 % men) and 97 controls (median age: 62 years (range: 24-87), 38.1 % men). The seropositivity rate for RBD IgG after 2 doses of vaccine in the cancer group was 81.6 % (n=164) and 93.8 % (n=91) in the control group (p=0.005). The median IgG titer of cancer patients was significantly lower than in the control group (338 (IQR, 95-933) AU/mL vs 676 (IQR, 389-1270) AU/mL; p= 60 patients than in <60 patients (75.9 % vs 89.4 %, p=0.014). DISCUSSION AND CONCLUSION: Cancer patients receiving an active systemic therapy with two doses of the CoronaVac vaccine had a lower antibody response than the non-cancer population, and deaths due to COVID-19 may occur in these patients despite the vaccine. Therefore, extensive protective measures should be taken to protect against COVID-19 in cancer patients aged 60 years and older, who have received two doses of the CoronaVac vaccine

A logarithmic model for hormone receptor-positive and breast cancer patients treated with neoadjuvant chemotherapy

OBJECTIVE: The aim of this study was to investigate the predictive importance of the previously validated log(ER)*log(PgR)/Ki-67 predictive model in a larger patient population.METHODS: Patients with hormone receptor positive/HER-2 negative and clinical node positive before chemotherapy were included. Log(ER)*log(PgR)/ Ki-67 values of the patients were determined, and the ideal cutoff value was calculated using a receiver operating characteristic curve analysis. It was analyzed with a logistic regression model along with other clinical and pathological characteristics.RESULTS: A total of 181 patients were included in the study. The ideal cutoff value for pathological response was 0.12 (area under the curve=0.585, p=0.032). In the univariate analysis, no statistical correlation was observed between luminal subtype (p=0.294), histological type (p=0.238), clinical t-stage (p=0.927), progesterone receptor level (p=0.261), Ki-67 cutoff value (p=0.425), and pathological complete response. There was a positive relationship between numerical increase in age and residual disease. As the grade of the patients increased, the probability of residual disease decreased. Patients with log(ER)*log(PgR)/Ki-67 above 0.12 had an approximately threefold increased risk of residual disease when compared to patients with 0.12 and below (odds ratio: 3.17, 95% confidence interval: 1.48-6.75, p=0.003). When age, grade, and logarithmic formula were assessed together, the logarithmic formula maintained its statistical significance (odds ratio: 2.47, 95% confidence interval: 1.07-5.69, p=0.034).CONCLUSION: In hormone receptor-positive breast cancer patients receiving neoadjuvant chemotherapy, the logarithmic model has been shown in a larger patient population to be an inexpensive, easy, and rapidly applicable predictive marker that can be used to predict response