Factors that influence treatment delay in patients with colorectal cancer

A prospective study was performed of patients diagnosed with colorectal cancer (CRC), distinguishing between colonic and rectal location, to determine the factors that may provoke a delay in the first treatment (DFT) provided.2749 patients diagnosed with CRC were studied. The study population was recruited between June 2010 and December 2012. DFT is defined as time elapsed between diagnosis and first treatment exceeding 30 days.Excessive treatment delay was recorded in 65.5% of the cases, and was more prevalent among rectal cancer patients. Independent predictor variables of DFT in colon cancer patients were a low level of education, small tumour, ex-smoker, asymptomatic at diagnosis and following the application of screening. Among rectal cancer patients, the corresponding factors were primary school education and being asymptomatic.We conclude that treatment delay in CRC patients is affected not only by clinicopathological factors, but also by sociocultural ones. Greater attention should be paid by the healthcare provider to social groups with less formal education, in order to optimise treatment attentio

Influence of Diagnostic Delay on Survival Rates for Patients with Colorectal Cancer

Colorectal cancer affects men and women alike. Sometimes, due to clinical-pathological factors, the absence of symptoms or the failure to conduct screening tests, its diagnosis may be delayed. However, it has not been conclusively shown that such a delay, especially when attributable to the health system, affects survival. The aim of the present study is to evaluate the overall survival rate of patients with a delayed diagnosis of colorectal cancer. This observational, prospective, multicenter study was conducted at 22 public hospitals located in nine Spanish provinces. For this analysis, 1688 patients with complete information in essential variables were included. The association between diagnostic delay and overall survival at five years, stratified according to tumor location, was estimated by the Kaplan-Meier method. Hazard ratios for this association were estimated using multivariable Cox regression models. The diagnostic delay ≥ 30 days was presented in 944 patients. The presence of a diagnostic delay of more than 30 days was not associated with a worse prognosis, contrary to a delay of less than 30 days (HR: 0.76, 0.64-0.90). In the multivariate analysis, a short delay maintained its predictive value (HR: 0.80, 0.66-0.98) regardless of age, BMI, Charlson index or TNM stage. A diagnostic delay of less than 30 days is an independent factor for short survival in patients with CRC. This association may arise because the clinical management of tumors with severe clinical characteristics and with a poorer prognosis are generally conducted more quickly.This study was supported by public grants from Instituto de Salud Carlos III (PI09/90397, PS09/00314, PS09/00746, PI09/90453, PI09/00910, PI09/90460, PI09/90490, PI13/01692, PI13/00013, PI18/01181, PI18/01589, PS0900805 & PI0900441) and was co-funded by the European Regional Development Fund.S

Valor predictivo de respuesta a la quimioterapia neoadyuvante en densidad de dosis, de los criterios de respuestas citológicos (CYCAR), en pacientes con cáncer de mama localizado

El cáncer de mama es la neoplasia maligna sólida más frecuente diagnosticada en las mujeres, considerándose un importante problema de salud pública. En cáncer de mama estadio localizado y localmente avanzado, es de gran interés la aplicación de quimioterapia previa a la cirugía (neoadyuvante), con el objeto de introducir de manera temprana el tratamiento sistémico sobre enfermedad micrometastásica, a la vez que disminuye el tamaño tumoral permitiendo un mayor número de cirugías conservadoras de la mama. Por otro lado, se busca alcanzar respuestas completas patológicas que se han relacionado con una mayor supervivencia. Estudios en este escenario aportan la ventaja de poder investigar in vivo la sensibilidad de diferentes esquemas terapeúticos y poder buscar marcadores biológicos de respuesta y pronósticos. Nosotros analizamos la eficacia de un esquema de quimioterapia con fármacos estándar pero administrados los cuatro primeros ciclos cada dos semanas, doxorrubicina-ciclofosfamida por cuatro ciclos, en densidad de dosis, seguido de cuatro ciclos de docetaxel cada 21 días, más trastuzumab (si existe sobreexpresión del her2-neu). Con objeto de conseguir un alto número de respuestas completas patológicas en pacientes con cáncer de mama. Por otro lado, es sabido el valor pronóstico y predictivo de la clasificación molecular de cáncer de mama en cuatro subtipos intrínsecos de Chuck Perou, pero en la práctica clínica habitual no se tiene acceso a estas determinaciones genómicas. Es por ello que en nuestro estudio pretendemos establecer el valor predictivo de respuesta y valor pronóstico de la clasificación histopatológica subrogada de Sant Gallen, para la quimioterapia neoadyuvante (QTN) administrada en densidad de dosis. A pesar de respuestas patológicas favorables con la QTN observamos recaídas posteriores en cáncer de mama localizado y localmente avanzado, haciéndonos pensar que existen otros factores determinantes en el patrón evolutivo de cada tumor, pendientes de descubrir y donde hay que centrar futuras investigaciones. Conocemos que en estadios muy tempranos del desarrollo del tumor se produce la diseminación de células tumorales circulantes y estas células pueden ser responsables de las posteriores recaídas de la enfermedad, así como de la falta de respuesta a los tratamientos administrados en estos pacientes diagnosticas en estadios II y III. La desaparición de células tumorales circulantes en sangre durante el tratamiento, se asocia con una mejor respuesta a la quimioterapia y con un mejor pronóstico en cuanto a menores recaídas y mayor supervivencia. Basándonos en estas premisas, pensamos que la incorporación de técnicas de detección y caracterización fenotípica de las CTCs de pacientes con cáncer de mama en estadios II-III, puede resultar útil como factor pronóstico y predictivo de la respuesta al tratamiento neoadyuvante, aportando información adicional sobre la capacidad proliferativa, invasiva y metastásica de las células diseminadas.Tesis Univ. Granada. Departamento de Medicina Física y RadiologíaProyecto de Investigació

Trabectedin as second-line treatment in metastatic myxoid liposarcoma: a case report

<p>Abstract</p> <p>Introduction</p> <p>Soft tissue sarcomas are heterogeneous tumors that are difficult to treat. Up to 50 percent of patients develop metastatic disease and require systemic chemotherapy. Ifosfamide and doxorubicin are the two most active agents.</p> <p>Case presentation</p> <p>A 33-year-old Caucasian woman presented to our facility with a metastatic myxoid liposarcoma. Our patient was initially treated with surgery and radiation therapy, but experienced three recurrences during a six-year period, the first and the last occurring while our patient was pregnant. The first recurrence, which occurred two years after diagnosis and was localized in the left cervical and right axillary region, was treated with surgery followed by chemotherapy. Molecular analysis of this tumor showed a t(12,16) + translocation resulting in a FUS-DDIT3 or EWSR1-DDIT3 fusion. Three years later our patient experienced a second recurrence in the left supraclavicular fossa, upper thoracic and anterior mediastinum, which was treated with surgery alone. Eight months later, during the second pregnancy, our patient experienced a third recurrence as a large cervical mass that was treated, upon pregnancy, with trabectedin (1.5mg/m²/24-hour continuous infusion) for a total of 12 cycles. At that time a computed tomography scan showed long-term partial response with excellent treatment tolerability.</p> <p>Conclusions</p> <p>This case report illustrates the potential therapeutic activity of trabectedin in patients with myxoid liposarcoma.</p

First hospital contact via the Emergency Department is an independent predictor of overall survival and disease-free survival in patients with colorectal cancer.

the aim of this study was to examine the possible association between the type of hospital admission and subsequent survival of the patient, as well as the pathological features recorded in a large population of patients with colorectal cancer. the study included 1,079 patients diagnosed with colon or rectal cancer in the Hospital Costa del Sol (Marbella, Spain). The relationship between patient survival rate and type of first admission to the hospital (elective or emergency admission) was assessed. The following variables were studied: age, gender, tumor location, pathological stage, differentiation grade, chemotherapy before surgery and survival. colon tumors are more common in patients admitted to hospital for the first time via the emergency service (63.7%) and the tumors tend to be poorly differentiated (64.2%) and metastatic (70%). These patients also present a more aggressive disease and a poorer prognosis than patients with an elective admission. With regard to patients from the Emergency Department, a Cox regression analysis showed a risk-ratio (RR) of 1.36 (confidence interval [CI] 95%: 1.11-1.66) for disease-free survival and of 1.41 (95% CI: 1.14-1.76) for overall survival. hospital admission via the Emergency Department is an indicator of aggressiveness and poorer prognosis compared to patients who enter via programmed routes

Impact of detection mode in a large cohort of women taking part in a breast screening program

Objective: the aim of this study was to evaluate the existing survival rate and clinical-pathological differences among patients with breast cancer detected by mammographic screening. Materials and methods: this multicenter cohort study examined 1,248 patients who took part in a national screening program for the early detection of breast cancer over an eight-year period. Results: of the two patient subgroups (interval and screening), we found significant differences in the distribution of prognostic factors, with interval cases presenting at a lower mean age (p = 0.002), with higher percentages of human epidermal growth factor receptor 2 (HER-2) or triple negative and lower percentages of luminal A or luminal B carcinomas (p = 0.001), advanced stages (p<0.001), lower hormone receptor expression (p<0.001), poorer differentiation (p<0.001) and lower survival (p<0.001). Among the screening group, patients with tumors detected during the first screening round had a significantly lower mean age (p<0.001), a lower frequency of comorbidities (p = 0.038) and a lower tendency (p<0.1) to be diagnosed as triple negative breast carcinomas than incident cases. Conclusion: our results highlight that breast tumors detected during the first screening round are frequently characterized by a more benign phenotype than the rest of the screening subgroups, which could be of help when stratifying the risk of death and selecting the best treatment option for each patient

Impact of adjuvant chemotherapy on the survival of patients with breast cancer diagnosed by screening

The aim of this study is to determine the survival of patients with breast cancer treated with adjuvant chemotherapy (ACh) after the diagnosis by screening, taking comorbidity into account. This multicenter cohort study examined a population of patients taking part in four national screening programs for the early detection of breast cancer (localized or locally advanced), during the period 2000-2008. Of the 1248 cancers detected, 266 were prevalent (21.3%), 633 were incident (50.7%), and 349 were interval (27.9%). No significant differences were detected between the three groups in terms of the distribution of comorbidity according to the CCI. After a median follow-up of 102 months, 22.1% of the patients with interval cancer had died. The corresponding figures for the incident and prevalent cancers were 10.4% and 7.9%, respectively (P < .001). The adjusted Cox regression analysis by the stage, CCI and group revealed no differences in the risk of recurrence between the different groups according to the ACh performed. However, there were significant differences in the overall survival; for the interval cancer group without ACh, the risk of death was higher (Hazard ratio: 2.5 [1.0-6.2]) than for the other two groups. However, for the prevalent and incident groups that did not receive ACh, there was no greater risk of death. This study shows that adjuvant chemotherapy seems to benefit patients with interval breast cancer, who have a poorer prognosis than those with prevalent or incident cancer. However, the role of ACh is unclear with respect to prevalent and incident cancers when comorbidity is taken into account

Factors Associated with Prolonged Patient-Attributable Delay in the Diagnosis of Colorectal Cancer.

The delayed diagnosis of colorectal cancer (CRC) may be attributable to sociodemographic characteristics, to aspects of tumour histopathology or to the functioning of the health system. We seek to determine which of these factors most influences prolonged patient-attributable delay (PPAD) in the diagnosis and treatment of CRC. A prospective, multicentre observational study was conducted in 22 Spanish hospitals. In total, 1,785 patients were recruited to the study between 2010 and 2012 and underwent elective or urgent surgery. PPAD is considered to occur when the time elapsed between a patient presenting the symptom and him/her seeking attention from the primary care physician or hospital emergency department exceeds 180 days. A bivariate analysis was performed to assess differences in variables segmented by tumour location and patient delay. Multivariate logistic regression analysis was performed on the outcome variable, PPAD. The rate of PPAD among this population was 12.1%. PPAD was significantly associated with altered bowel rhythm (odds ratio [OR], 1.36; 95% confidence interval [CI], 1.02 to 1.83) and with adenocarcinoma histology, in comparison with mucinous adenocarcinoma (OR, 2.03; 95% CI, 1.11 to 3.71). Other sociocultural factors and clinicopathological features were not independent predictors of PPAD. Many patients do not consider altered bowel rhythm an alarming symptom, warranting a visit to the doctor. PPAD could be reduced by improving health education, raising awareness of CRC-related symptoms