Search

Advances in treatment of oligodendroglioma represent arguably the most significant recent development in the treatment of brain tumors, with multiple clinical trials demonstrating that median survival is approximately doubled in patients with World Health Organization grade II and III 1p/19q codeleted gliomas (ie, oligodendrogliomas) treated with procarbazine, lomustine, vincristine chemotherapy and radiation vs radiation alone. However, chemoradiotherapy itself is not without morbidity, including both short-term toxicities primarily related to chemotherapy and longer-term cognitive issues likely due to radiation. Patients and physicians both desire maximally effective therapy with minimal toxicity, and it remains unclear whether some patients with macroscopic residual disease after surgery can safely delay therapy, to avoid or delay toxicity, while simultaneously preserving the full benefits of treatment. In this article, experts in the field discuss the rationale for the approaches of up-front treatment with chemoradiotherapy and initial observation, respectively.

Purpose/Objective(s) The 2019 coronavirus pandemic (COVID-19) had a broad impact on the care of cancer patients, including the rapid adoption of telehealth video visits. On March 15, 2020, our institutional leadership recommended transition to video visits, which posed a risk of altering patients’ access to care. We assessed the impact of this rapid transition on demographic patterns in an urban academic radiation oncology department. Materials/Methods Consultation and follow-up visits from the pre-COVID-19 period (January 1, 2019 to March 14, 2020) and COVID-19 period (March 15, 2020 to August 31, 2020) in a single radiation oncology department were identified. Demographics and appointment data were abstracted from the institutional electronic health record. Time trends and patient and visit characteristics were compared across the pre-COVID-19 and COVID-19 periods. Results During the study period, 9,450 consult and follow-up visits were performed pre-COVID-19 and 3,298 visits in the COVID-19 period. The proportion of video visits increased markedly in the transition period, from 0.6% of all visits in the week of March 2, 2020, to 87% in the week of March 23, 2020. In-person visits decreased from 98% to 3%. Among all visits (in-person and telehealth), those during the COVID-19 period were less likely to be new consultations (43.1% from 60.1%; P < 0.001). There was a small and significant increase in the proportion of visits with patients who: identified as white (61.8% from 58.4%, P = 0.019), spoke English as their primary language (91.3% from 89.4%, P = 0.002), and had commercial insurance (34.1% from 32.0%; P = 0.009). Conclusion The overall COVID-19 clinic population retained demographic features similar to the pre-COVID-19 population despite a very rapid near-complete transition to telehealth. Nonetheless, the telehealth-predominant COVID-19 period had slightly increased visits with patients who were white or primarily English speaking or had commercial insurance. Strategies for ensuring telehealth is accessible to diverse populations should be a priority as telemedicine is integrated into long-term clinical operations.

BackgroundA significant proportion of patients with advanced cancer undergo palliative radiotherapy (RT) within their last 30 days of life. This study characterizes palliative RT at our institution and aims to identify patients who may experience limited benefit from RT due to imminent mortality.MethodsFive hundred and-eighteen patients treated with external beam RT to a site of metastatic disease between 2012 and 2016 were included. Mann-Whitney U and chi-squared tests were used to identify factors associated with RT within 30 days of death (D30RT).ResultsMedian age at RT was 63 years (IQR 54-71). Median time from RT to death was 74 days (IQR 33-174). One hundred and twenty-five patients (24%) died within 30 days of RT. D30RT was associated with older age at RT (64 vs. 62 years, p= 0.04), shorter interval since diagnosis (14 vs. 31 months, p&nbsp

Metastatic non-small cell lung cancer (NSCLC) is known to have a particularly poor prognosis, with a median overall survival of 8 months and a 10% survival rate at 2 years (1). Historically, treatment for metastatic NSCLC has been palliative chemotherapy (2) which has been shown to modestly prolong 1-year survival in comparison with best supportive care (3). Nowadays, with the advent of more sensitive imaging modalities, improvement in the specificity of radiation therapy delivery, and targeted systemic therapies, many patients with limited metastatic disease are being detected and treated more aggressively, in the absence of randomized, prospective data to support these practices. In patients with metastatic lung cancer, where obstructive or functionally limiting manifestations of disease can reduce performance status and diminish quality of life, there may be a uniquely important role for early enactment of locally directed therapy.