Anxiety and depression in adult cancer patients: ESMO Clinical Practice Guideline

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Care of the adult cancer patient at the end of life: ESMO Clinical Practice Guidelines.

ESMO guideline on best clinical practice in the management of patients at end-of-lif

Prevalence of Fatigue in Head and Neck Cancer Survivors

Introduction: In head and neck cancer (HNC) patients, fatigue is present throughout the course of treatment and during follow-up. There are limited data about the prevalence and factors associated with fatigue in HNC survivors. The objectives of this study were to assess the prevalence of fatigue and its interference with daily life activities and examine the association between fatigue and gender, age, primary tumour site, Human Papillomavirus (HPV) status, previous oncologic therapy, and time since end of treatment. Methods: Consecutive locally advanced HNC patients having completed curative treatment at least 1 year earlier and free of disease were asked to fill in the Brief Fatigue Inventory (BFI) questionnaire. Fatigue was categorized according to BFI average score as absent (0), mild (>0 to 6 to 6410). Results: From February 2015 to July 2016, 129 patients (median age = 60 years old; 67% male) were evaluated. Primary sites of cancer were oropharynx (46%, with 4/5 patients HPV positive), nasopharynx (22%), larynx/hypopharynx (14%), oral cavity (13%), and paranasal sinus or salivary gland (5%). Oncologic treatment was completed 12 to 96 months earlier (median = 34 months). Fatigue was reported as absent in 15% of the patients, mild in 67%, moderate in 11%, and severe in 7%. No association between BFI average score and the analyzed variables was identified. Discussion: Moderate and severe fatigue was reported in 18% of HNC survivors. Further research is needed to assess its causes and improve the management

Insomnia in adult patients with cancer: ESMO Clinical Practice Guideline

Sleep disturbance is a common problem in patients with cancer, regardless of cancer type, stage and phase of treatment. Sleep disorders can be identified using the criteria of the World Health Organization International Classification of Diseases 11th edition (ICD-11) (updated chapter on ‘Sleep–wake disorders’), the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders fifth edition – Text Revision (DSM-5-TR) and the American Academy of Sleep Medicine (AASM) International Classification of Sleep Disorders (ICSD) third edition..

Alveolar bone histological necrosis observed prior to extractions in patients, who received bone-targeting agents

Objective: We reported the alveolar bone histology prior to dental extractions in cancer patients, who received bone-targeting agents (BTA). Subjects and Methods: Fifty-four patients were included. Patients underwent extractions, and bone biopsies were taken. Results: Extractions were performed due to pain, swelling, purulence, fistula, and numbness, not responding to treatment, in 40 patients (group A); extractions due to asymptomatic, non-restorable teeth, were performed in 14 patients (group B). Complete alveolar jaw bone histological necrosis was observed in 28 of 40 (70%) patients of group A and none of group B (p <.001). The development of clinical osteonecrosis (MRON) was assessed in 44 patients; 10 patients, who were also treated with Low Level Laser Treatments-LLLT, were excluded from this analysis, as the alternative therapies were a confounding factor. Twelve patients, with alveolar bone histological necrosis prior to extraction, developed medication-related osteonecrosis of the jaw (MRONJ) compared with two patients with vital or mixed vital/non-vital bone (p <.0007). BTAs >1 year and concurrent targeted therapy were also significantly associated with MRONJ (p =.016 and p =.050). Conclusion: Pain, swelling, purulence, fistula, and numbness were significantly associated with complete bone histological necrosis prior to extractions and increased MRONJ development. Research is justified to explore whether histological necrosis represents an early stage of osteonecrosis. © 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd. All rights reserve