The Measurement of Lymphokines in Cancer Patients and its Implications in Diagnostic Testing

2015 ◽  
pp. 32-37 ◽  
Author(s):  
B. W. Papermaster
Keyword(s):  
Cancer Patients ◽  
Diagnostic Testing

Accuracy and usefulness of a clinical prediction rule and D-dimer testing in excluding deep vein thrombosis (DVT) in cancer patients

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 19522-19522
Author(s):  
M. Carrier ◽  
A. Lee ◽  
S. Bates ◽  
P. S. Wells
Keyword(s):  
Cancer Patients ◽  
Diagnostic Testing ◽  
Prediction Rule ◽  
Clinical Prediction Rule ◽  
Clinical Prediction ◽  
Probability Score ◽  
Vein Thrombosis ◽  
Clinical Probability ◽  
Low Probability ◽  
D Dimer

19522 Background: Cancer patients frequently present with thrombotic complications and rapid, accurate diagnostic testing would reduce morbidity and mortality. Although the combination of a low clinical probability using clinical prediction rules (e.g. Well’s Score) and a negative D-dimer result have proven to be safe and reliable in ruling out DVT in the general population, the accuracy of such a strategy is less certain in cancer patients. Because cancer patients often have alternative reasons for leg swelling and pain, and because malignancy and chemotherapy can render the D-dimer test positive in the absence of DVT, we hypothesize that the Well’s Score and D-dimer testing are potentially less accurate and less useful in excluding DVT in patients with active cancer. Methods: We performed a retrospective analysis of 2 prospective studies to compare the diagnostic test characteristics of the Well’s Score and D-dimer testing between patients with and without cancer presenting with suspected DVT. Results: A total of 1630 patients were studied; 107 had cancer. DVT was confirmed in 39.3% of patients with and 13.7% of patients without cancer. In both patient groups, the proportions of patients with DVT were significantly different among the high-, moderate- and low-probability groups according to the Well’s score (P<0.001). However, significantly fewer cancer patients (19.6%) had a low-probability score compared to patients without cancer (47.5%) (P<0.001). Similarly, 36.4% of cancer vs. 60.4% of noncancer patients had a negative D-dimer result (P<0.001). In cancer patients, a low probability score alone had a sensitivity of 95.2% (95%CI 82.6%-99.2%) and a specificity of 29.2% (95% CI 18.9%-42.0%). In combination with D-dimer testing, the sensitivity improved to 100% (95%CI 31.0%-100%) but the specificity was reduced to 26.4% (95%CI 13.5%-44.7%). In contrast, the specificity in patients without cancer was preserved at 53.9% (95%CI 50.4%-57.3%). Conclusion: DVT can be ruled out in cancer patients with a low clinical probability of DVT and a negative D-dimer result. However, the low specificity of these tests excludes very few patients and thereby limits their clinical usefulness. No significant financial relationships to disclose.

Prevalence and incidence of comorbidities associated with gastric cancer.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 39-39 ◽  
Author(s):  
Mark D. Danese ◽  
Michelle L. Gleeson ◽  
Wendy J. Langeberg ◽  
Juan Ke ◽  
Michael A. Kelsh
Keyword(s):  
Gastric Cancer ◽  
Cancer Patients ◽  
Index Date ◽  
Diagnostic Testing ◽  
Incidence Rates ◽  
Physician Visits ◽  
Diagnosis Of Cancer ◽  
Gastric Cancer Patients ◽  
New Treatments ◽  
Treatment Table

39 Background: Understanding the burden of comorbidities in patients with gastric cancer may aid in treatment planning and evaluating the safety of new treatments. Methods: Using the Surveillance, Epidemiology, and End Results (SEER)–Medicare combined dataset, we identified 12,612 patients diagnosed with gastric cancer 2000–2007. A cohort of 12,612 cancer-free individuals was frequency-matched by Medicare enrollment year and county of residence. Subjects were ≥66 years-old at index date to allow for ≥1 full year of Medicare coverage. Prevalence the year before index date and 3- and 12-month incidence rates (per 100 person-years) after index date were estimated for 42 common comorbidities. Results: Comorbidities with the highest (≥8%) 3-month incidence in patients with gastric cancer are shown. Conclusions: Comorbidity prevalence before index date was modestly higher, and incidence rates after index date were much higher in gastric cancer patients than in cancer-free individuals. The potential reasons for this include the increased diagnostic testing, physician visits, and reporting of morbidities that occurs with the diagnosis of cancer, as well as the effects of cancer and its treatment. [Table: see text]

scholarly journals Lung cancer survival in Norway, 1997–2011: from nihilism to optimism

2015 ◽  
Vol 47 (1) ◽  
pp. 275-287 ◽  
Author(s):  
Yngvar Nilssen ◽  
Trond Eirik Strand ◽  
Lars Fjellbirkeland ◽  
Kristian Bartnes ◽  
Bjørn Møller
Keyword(s):  
Lung Cancer ◽  
Cancer Patients ◽  
Cancer Survival ◽  
Treatment Options ◽  
Diagnostic Testing ◽  
Relative Survival ◽  
Population Based ◽  
Related Factors ◽  
Lung Cancer Patients ◽  
Lung Cancer Survival

We examine changes in survival and patient-, tumour- and treatment-related factors among resected and nonresected lung cancer patients, and identify subgroups with the largest and smallest survival improvements.National population-based data from the Cancer Registry of Norway, Statistics Norway and the Norwegian Patient Register were linked for lung cancer patients diagnosed during 1997–2011. The 1- and 5-year relative survival were estimated, and Cox proportional hazard regression, adjusted for selected patient characteristics, was used to assess prognostic factors for survival in lung cancer patients overall and stratified by resection status.We identified 34 157 patients with lung cancer. The proportion of histological diagnoses accompanied by molecular genetics testing increased from 0% to 26%, while those accompanied by immunohistochemistry increased from 8% to 26%. The 1-year relative survival among nonresected and resected patients increased from 21.7% to 34.2% and 75.4% to 91.5%, respectively. The improved survival remained significant after adjustment for age, sex, stage and histology. The largest improvements in survival occurred among resected and adenocarcinoma patients, while patients ≥80 years experienced the smallest increase.Lung cancer survival has increased considerably in Norway. The explanation is probably multifactorial, including improved attitude towards diagnostic work-up and treatment, and more accurate diagnostic testing that allows for improved selection for resection and improved treatment options.

Rate and Time Course of Thromboembolism Events in Cancer Patients

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4773-4773
Author(s):  
Russell D Hull ◽  
Tazmin Merali ◽  
Allan Mills ◽  
Jane Liang ◽  
Nelly Komari
Keyword(s):  
Cancer Treatment ◽  
Cancer Patients ◽  
Time Course ◽  
Randomized Clinical Trials ◽  
Diagnostic Testing ◽  
Real Life ◽  
Medical Patients ◽  
Case Record ◽  
Vte Prophylaxis ◽  
Active Cancer

Abstract Abstract 4773 Background: Venous thromboembolism (VTE) prophylaxis has been recommended in clinical guidelines as an appropriate strategy for hospitalized cancer patients based on evidence of reduced VTE events and reduced mortality. However, current guidelines do not specify the appropriate length of VTE prophylaxis in this population. Real world data is needed to understand the prevalence of symptomatic and confirmed VTE for this patient population to help clinicians determine strategies regarding the appropriate duration of treatment. Objective: To document the incidence of symptomatic late VTE events in hospitalized patients who have active cancer. Methods: Charts from 1134 consecutive medical patients age > 60 years who were hospitalized in the Calgary region and discharged between January and February 2008 were abstracted using standardized case record forms. All hospitals in the region use a common unique patient identifier number, thus enabling the tracking of subsequent patient visits to the emergency room, inpatient admissions or outpatient visits occurring anywhere in the region's acute care system. Any identified patient was followed for a subsequent visit related to VTE. Active cancer patients were defined as those who have a cancer diagnosis at hospital admission and have a planned cancer surgery or receiving cancer treatment or were receiving palliative treatment or whose cancer treatment was not specified. Records were excluded if the patient was admitted for VTE or to rule out VTE, receiving chronic anticoagulation, experiencing acute coronary syndromes, had a hospital stay ≤ 3 days, had a remote cancer history, was a surgical or orthopedic patient, or pregnant. Data was collected on the timing of VTE related events for up to 100 days post discharge. Results: A total of 358 patients met criteria over the review period. Seventy-three percent (261/358) of all active cancer patients received mechanical or pharmacological prophylaxis in hospital. Twenty-three percent of these patients were identified as requiring medical care for symptoms associated with VTE. Confirmation of VTE by diagnostic testing occurred in 4.8% (95% CI, 2.6% to 7%) while the other 18% (95% CI, 14.0% to 22%) had diagnostic tests that were negative or inconclusive. The mean length of time to confirmed first VTE event was 38.2 days post admission. Conclusion: This study demonstrates that in a real life setting 23% of active cancer patients would develop symptoms of VTE requiring a health professional's attention with 4.8% having VTE confirmed by diagnostic testing. These events occurred despite thromboprophylaxis in hospital and suggest that the risk of symptomatic VTE could be higher in real life compared to that reported in randomized clinical trials where patients are screened for asymptomatic VTE. These findings show that the prevalence of VTE warrants consideration of extended thromboprophylaxis in active cancer patients, as the benefits of extended prophylactic therapy may outweigh the risks in this population. Disclosures: Hull: sanofi-aventis: Consultancy; LEO Pharma: Consultancy; Pfizer: Consultancy; Portola: Consultancy; Merck: Consultancy; Bayer: Consultancy; Johnson & Johnson: Consultancy. Merali:sanofi-aventis: Consultancy; Amgen: Consultancy; Pfizer: Consultancy; BMS: Consultancy; Abbott: Consultancy; Boehringer Ingelheim: Consultancy; Genzyme: Consultancy; LEO Pharma: Consultancy; Nycomed: Consultancy; Otsuka: Consultancy. Mills:Pfizer: Consultancy; sanofi-aventis: Research Funding. Komari:sanofi-aventis: Employment.

The role of non-oncology specialties in the real world longitudinal journey of prostate cancer patients.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e19255-e19255
Author(s):  
Daniel Carnegie ◽  
Elenee Argentinis ◽  
Dibyajyoti Mazumder ◽  
Indu Dhangar
Keyword(s):  
Prostate Cancer ◽  
Cancer Patients ◽  
Real World ◽  
Index Date ◽  
Diagnostic Testing ◽  
Significant Proportion ◽  
Data Repository ◽  
Electronic Health Record Data ◽  
Source Data ◽  
Electronic Health

e19255 Background: Electronic health records (EHRs) are increasingly being recognized by regulators and researchers as reliable sources of evidence. It is therefore critical that real world evidence databases accurately reflect all diagnostics and interventions that could affect patient outcomes. Some of the commercially available datasets source data solely from oncology clinics, which may not reflect patients’ full care journey. This analysis assessed the contribution of non-oncology specialties to prostate cancer care. Methods: Newly diagnosed prostate cancer patients with encounters between Jan 2014 to Dec 2017 were analyzed from the deidentified Optum Electronic Health Record Data Repository. Diagnostic procedures 6 months prior to the index date (first diagnosis date within the study period) and 1 year post index date were identified. Attending physician specialties were identified. All treatment related encounters up to 1 year post the index dates were mapped by specialty. Codes were verified by certified medical professional. Results: A total of 186,299 prostate cancer patients were identified between Jan 2014 to Dec 2017. In the 6 months prior to index date, biopsy was most commonly ordered by urologists (70%), followed by surgical specialists (14%). Biomarker tests were ordered mostly by general practitioners (40%) followed by urologists (18%). The trend was similar for 1 year post biopsy and other histology procedures. Interestingly, a large portion of treatment encounters was observed outside oncology: 48% of surgical management by urologists (48%), chemotherapy was prescribed by both oncologists (27%) and urologists (31%) in a similar ratio, while radiotherapy was performed predominantly by radiation oncologists (81%). Conclusions: In prostate cancer, a large proportion of care encounters occur outside oncology specialties, with urology conducting a significant proportion of diagnostic testing and early treatment. Restricting source data to oncology specialties may omit key factors affecting patients’ outcomes, therefore data for such studies should reflect the entire care continuum.

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