34 results on '"Vithusha Ganesh"'
Search Results
2. Re-analysis of symptom clusters in advanced cancer patients attending a palliative outpatient radiotherapy clinic
- Author
-
Yasmeen Razvi, Matthew K. Hwang, May Tsao, Vithusha Ganesh, Pearl Zaki, Liying Zhang, Stephanie Chan, Edward Chow, Erin McKenzie, Carlo DeAngelis, and Elizabeth Barnes
- Subjects
Male ,medicine.medical_specialty ,Palliative care ,Nausea ,medicine.medical_treatment ,Bone Neoplasms ,Ambulatory Care Facilities ,03 medical and health sciences ,0302 clinical medicine ,Sickness Impact Profile ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Depression (differential diagnoses) ,Aged ,Retrospective Studies ,Advanced and Specialized Nursing ,business.industry ,Palliative Care ,Cancer ,medicine.disease ,Advanced cancer ,Exploratory factor analysis ,Radiation therapy ,Anesthesiology and Pain Medicine ,030220 oncology & carcinogenesis ,Quality of Life ,Anxiety ,Female ,Symptom Assessment ,medicine.symptom ,business - Abstract
Background: Cancer patients often present with several concurrent symptoms. There is evidence to suggest that related symptoms can cluster together in stable groups. The present study sought to identify symptom clusters in advanced cancer patients using the Edmonton Symptom Assessment System (ESAS) in a palliative outpatient radiotherapy clinic. Methods: Principal component analysis (PCA), exploratory factor analysis (EFA), and hierarchical cluster analysis (HCA) were used to identify symptom clusters among the 9 ESAS items using ESAS scores from each patient’s first visit. Results: PCA identified three symptom clusters (cluster 1: depression, anxiety; cluster 2: nausea, dyspnea, loss of appetite; cluster 3: pain, well-being, tiredness, drowsiness). EFA identified two clusters (cluster 1: tiredness, drowsiness, loss of appetite, well-being, pain, nausea, dyspnea; cluster 2: depression, anxiety). HCA identified three symptom clusters (cluster 1: depression, anxiety, pain, well-being; cluster 2: tiredness, drowsiness, dyspnea; cluster 3: nausea, loss of appetite). Conclusions: Symptom clusters were identified using three analytical methods. The following items were always in the same cluster: depression and anxiety; nausea and appetite loss; well-being and pain; tiredness and drowsiness. Further research in symptom clusters is necessary to advance our understanding of the complex symptom interactions in advanced cancer patients and to determine the most clinically relevant symptom clusters.
- Published
- 2019
3. Evaluation of the 3-day recall period for the Functional Life Index-Emesis (FLIE)
- Author
-
Edward Chow, Caitlin Yee, Bo Angela Wan, Leah Drost, Mark Pasetka, Carlo DeAngelis, Elizabeth Barnes, Liying Zhang, Vithusha Ganesh, and May Tsao
- Subjects
Adult ,Male ,medicine.medical_specialty ,Time Factors ,Vomiting ,Nausea ,Bone Neoplasms ,Granisetron ,Severity of Illness Index ,Ondansetron ,Quality of life ,Surveys and Questionnaires ,Internal medicine ,Humans ,Medicine ,Neoplasm Metastasis ,Aprepitant ,Aged ,Aged, 80 and over ,Advanced and Specialized Nursing ,business.industry ,Palliative Care ,Palonosetron ,Reproducibility of Results ,Middle Aged ,Anesthesiology and Pain Medicine ,Concordance correlation coefficient ,Quality of Life ,Antiemetics ,Female ,medicine.symptom ,business ,medicine.drug - Abstract
Background: Nausea and vomiting are commonly experienced by cancer patients, and can be assessed by the Functional Life Index-Emesis (FLIE) instrument which employs a three-day recall period. However, it is unknown whether patients’ responses to the FLIE better correlate with the average or the worst symptom severity of the recall period, or the severity of an individual day. Methods: Patients receiving emetogenic radiotherapy for painful bone metastases who were enrolled in one of three trials for anti-emetic medications (ondansetron, aprepitant/granisetron, or palonosetron) completed the FLIE at baseline, and days 3, 5, 7, or 10 during treatment and follow-up. The concordance correlation coefficient (rc) was calculated between FLIE overall nausea and vomiting and daily nausea, vomiting, and quality of life (QoL) using the average responses of the 3-day recall period and with each of the three days’ responses. Results: Responses from eighty-nine patients who experienced nausea or vomiting were analysed. The highest concordance for FLIE nausea was with the 3-day average [during treatment: rc =0.698, 95% confidence interval (CI): 0.495, 0.829; follow-up: rc =0.821, 95% CI: 0.711, 0.892]. FLIE vomiting had the highest concordance with worst day vomiting (during treatment, rc =0.310, 95% CI: 0.194, 0.417) or two day-prior vomiting (follow-up, rc =0.902, 95% CI: 0.832, 0.944). FLIE nausea and vomiting had inconsistent concordances with daily assessments of QoL. Conclusions: Responses to the FLIE questionnaire are most representative of average nausea severity. Larger cohorts to validate these findings are warranted to address the lack of power in this present study and to confirm the wording and justification of a three-day recall period for the FLIE.
- Published
- 2018
4. Management of radiation-induced nausea and vomiting with palonosetron in patients with pre-existing emesis: a pilot study
- Author
-
May Tsao, Pearl Zaki, Leah Drost, Mark Pasetka, Carlo DeAngelis, Elizabeth Barnes, Hans Chung, Stephanie Chan, Vithusha Ganesh, Caitlin Yee, Edward Chow, Bo Angela Wan, Liying Zhang, and Natalie Pulenzas
- Subjects
Male ,Vomiting ,Nausea ,medicine.medical_treatment ,Administration, Oral ,Pilot Projects ,03 medical and health sciences ,0302 clinical medicine ,Quality of life ,Neoplasms ,Surveys and Questionnaires ,medicine ,Humans ,In patient ,030212 general & internal medicine ,Aged ,Aged, 80 and over ,Advanced and Specialized Nursing ,Chemotherapy ,business.industry ,Palliative Care ,Palonosetron ,Cancer ,Middle Aged ,medicine.disease ,Radiation therapy ,Anesthesiology and Pain Medicine ,030220 oncology & carcinogenesis ,Anesthesia ,Quality of Life ,Antiemetics ,Female ,medicine.symptom ,business ,medicine.drug - Abstract
Background: Approved almost 15 years ago for use in the chemotherapy setting, palonosetron, a 2nd generation 5-hydroxtryptamine 3 receptor antagonist (5-HT3 RA), has demonstrated efficacy in preventing chemotherapy-induced nausea and vomiting. However, its utility in the prophylaxis and treatment of radiation-induced nausea and vomiting (RINV) has yet to be evaluated. In this pilot study, we investigated the rates of control in RINV in patients with pre-existing emesis. Methods: Patients with pre-existing emesis undergoing palliative radiotherapy to sites with emetic risk were prescribed palonosetron 0.5 mg before the start of radiation treatment, and every other day until completion of treatment. Patients were followed up in acute (day 1 of treatment to day 1 after treatment) and delayed phases (days 2–10 after treatment). Prophylaxis and rescue (PR) was defined as a decrease in anti-emetic use, or episodes of nausea and/or vomiting from baseline. Complete prophylaxis (CP) was defined as no increase in anti-emetic use, or episodes of nausea and/or vomiting. Secondary endpoints included control of nausea and quality of life (QOL), as assessed with the Functional Living Index—Emesis and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire—Core 15 Palliative. Results: Fourteen patients were enrolled. Rates of control were higher in the acute phase (n=14) for nausea (PR =42.9%, CP =42.9%) and vomiting (PR =21.4%, CP =71.4%) compared to the delayed phase (n=13) for nausea (PR =42.9%, CP =7.7%) and vomiting (PR =15.4%, CP =53.8%). Conclusions: Palonosetron appears to be safe and patients with pre-existing emesis receiving palliative radiotherapy. More studies are needed to investigate its efficacy in this patient population.
- Published
- 2018
5. A pilot study with palonosetron in the prophylaxis of radiation-induced nausea and vomiting
- Author
-
May Tsao, Pearl Zaki, Mark Pasetka, Carlo DeAngelis, Elizabeth Barnes, Liying Zhang, Natalie Pulenzas, Edward Chow, Caitlin Yee, Hans Chung, Vithusha Ganesh, Stephanie Chan, Bo Angela Wan, and Leah Drost
- Subjects
Adult ,Male ,Quinuclidines ,Vomiting ,medicine.drug_class ,Nausea ,medicine.medical_treatment ,Pilot Projects ,030218 nuclear medicine & medical imaging ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Quality of life ,Randomized controlled trial ,law ,Neoplasms ,medicine ,Clinical endpoint ,Humans ,Antiemetic ,Aged ,Aged, 80 and over ,Advanced and Specialized Nursing ,Radiotherapy ,business.industry ,Palonosetron ,Middle Aged ,Isoquinolines ,Radiation therapy ,Anesthesiology and Pain Medicine ,030220 oncology & carcinogenesis ,Anesthesia ,Female ,Serotonin Antagonists ,medicine.symptom ,business ,medicine.drug - Abstract
Background: Palonosetron is an effective antiemetic in chemotherapy-induced nausea and vomiting (CINV), but has yet to be studied in the radiation setting. The purpose of the present study was to investigate the efficacy and safety of palonosetron in the prophylaxis of radiation-induced nausea and vomiting (RINV). Methods: Patients without existing nausea and vomiting undergoing palliative radiotherapy to sites with emetic risk were prescribed palonosetron 0.5 mg orally before the start of radiation treatment, and every other day until completion of treatment. Patients were followed up in acute (day 1 of treatment to day 1 after treatment) and delayed phases (days 2–10 after treatment). The primary endpoint was control of vomiting. Complete control was defined as no use of rescue medication and no episodes of nausea or vomiting. Secondary endpoints included control of nausea and quality of life (QOL). QOL was assessed with the Functional Living Index—Emesis and the European Organisation for Research and Treatment of Cancer QOL Questionnaire—Core 15 Palliative (C15-PAL). Results: In all evaluable patients (n=75), complete control of vomiting was 93.3% in the acute phase and 93.2% in the delayed phase. Complete control of nausea was 74.7% in the acute phase and 74.0% in the delayed phase. Conclusions: Results suggest improved control in RINV compared to historical reports with first generation serotonin receptor antagonists (RA). A randomized study will be needed to confirm this finding.
- Published
- 2018
6. Symptom clusters using the EORTC QLQ-C15-PAL in palliative radiotherapy
- Author
-
Leah Drost, Vithusha Ganesh, Liying Zhang, Edward Chow, Hans Chung, Bo Angela Wan, Carlo DeAngelis, Elizabeth Barnes, May Tsao, and Patrick Diaz
- Subjects
Male ,medicine.medical_specialty ,Palliative care ,Nausea ,medicine.medical_treatment ,Bone Neoplasms ,03 medical and health sciences ,Eortc qlq c15 pal ,0302 clinical medicine ,Cronbach's alpha ,030502 gerontology ,Palliative radiotherapy ,Internal medicine ,medicine ,Humans ,Pain Management ,Aged ,Aged, 80 and over ,Advanced and Specialized Nursing ,Radiotherapy ,business.industry ,Palliative Care ,Cancer ,Cancer Pain ,Syndrome ,Middle Aged ,medicine.disease ,Exploratory factor analysis ,Radiation therapy ,Anesthesiology and Pain Medicine ,030220 oncology & carcinogenesis ,Female ,medicine.symptom ,0305 other medical science ,business - Abstract
Background: Patients with advanced cancer often experience a multitude of symptoms. Due to the potential interrelation of symptoms, symptom clusters of 2 or more concurrent symptoms have been advocated for use in the palliative setting to provide better management of symptoms. Methods: The principal component analysis (PCA), exploratory factor analysis (EFA) and hierarchal cluster analysis (HCA) were conducted on responses to items 1–14 in the European Organisation for Research and Treatment of Cancer Quality of Life-C15-Palliative (EORTC QLQ-C15-PAL) at baseline and days 5 and 10 following RT. Results: There was complete data for 109, 90 and 87 patients at baseline, day 5 and day 10 respectively. The average age was 72 years. The most common site of primary was the prostate (36.7%), and almost all patients presented with bone metastases (95.4%). Analyses identified 2–4 clusters at each interval. From baseline to day 10 follow-up, across all analyses, items associated with physical functioning clustered consistently with shortness of breath. Pain and pain interference clustered with nausea at baseline; and with sleep at both follow-up intervals. Cronbach’s alpha values for the clusters ranged from 0.53 to 0.90. Conclusions: Fluctuation of symptom clusters was observed in a short time frame following palliative RT. Although clusters were dynamic, several items tended to cluster together. Further research is required to validate these clusters.
- Published
- 2018
7. Symptom clusters using the Brief Pain Inventory in patients with breast cancer
- Author
-
Leah Drost, Carlo DeAngelis, Nicholas Chiu, Nicholas Lao, Leonard Chiu, Liying Zhang, Justin Lee, Bo Angela Wan, Edward Chow, Vithusha Ganesh, and Ronald Chow
- Subjects
Adult ,medicine.medical_specialty ,Paclitaxel ,Varimax rotation ,Antineoplastic Agents ,Breast Neoplasms ,Docetaxel ,03 medical and health sciences ,0302 clinical medicine ,Breast cancer ,Quality of life ,medicine ,Humans ,In patient ,Prospective Studies ,030212 general & internal medicine ,Brief Pain Inventory ,Aged ,Pain Measurement ,Aged, 80 and over ,Advanced and Specialized Nursing ,030504 nursing ,business.industry ,Cancer Pain ,Middle Aged ,medicine.disease ,Anesthesiology and Pain Medicine ,Mood ,Quality of Life ,Physical therapy ,Functional interference ,Female ,Taxoids ,0305 other medical science ,business ,Psychosocial - Abstract
Background: The purpose of this study was to assess symptom clusters in functional interference using the brief pain inventory (BPI) in patients with non-metastatic breast cancer (BC) during and after chemotherapy. Methods: A principal component analysis with varimax rotation was conducted on data from 228 patients to identify two clusters at baseline and two intervals following treatment. Results: Physical (general activity, normal work, walking ability) and psychosocial (mood, relationships, sleep, enjoyment of life) interference clusters were present at baseline. Clusters were observed at 1-month (cluster 1: general activity, normal work, enjoyment of life; cluster 2: relationships, sleep) and 3-month (cluster 1: general activity, normal work, relationships; cluster 2: sleep, enjoyment of life) post-treatment. Conclusions: Results from our study suggest dynamic symptom clusters in this patient population, and encourage continued symptom management following completion of treatment.
- Published
- 2017
8. Efficacy of postoperative radiation treatment for bone metastases in the extremities
- Author
-
Henry Lam, May Tsao, Michael Ford, Stephanie Chan, Edward Chow, Elizabeth Barnes, Vithusha Ganesh, Albert Yee, Angela Turner, Bo Angela Wan, Leah Drost, Monique Christakis, Joel S. Finkelstein, and Srinivas Raman
- Subjects
Adult ,Male ,Reoperation ,medicine.medical_specialty ,medicine.medical_treatment ,Bone Neoplasms ,Prosthesis ,Re-Irradiation ,03 medical and health sciences ,0302 clinical medicine ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Postoperative Period ,Radiological imaging ,Aged ,Retrospective Studies ,Fixation (histology) ,Postoperative Care ,030222 orthopedics ,business.industry ,Postoperative radiation ,Extremities ,Hematology ,Middle Aged ,Surgery ,Fractures, Spontaneous ,Oncology ,Tumor progression ,030220 oncology & carcinogenesis ,Cohort ,Palliative radiation ,Female ,Radiotherapy, Adjuvant ,Radiology ,Pathological fractures ,business - Abstract
Background and purpose Impending or pathological fractures due to bone metastases may require surgical fixation. Postoperative radiation is often recommended to reduce local progression and prevent prosthesis displacement, hence reducing the need for second surgery. The objectives of this study were to investigate the need for second surgery, and to report on rates of re-irradiation, tumor progression and prosthesis displacement following postoperative radiation. Materials and methods Data were collected from 65 patients who received postoperative radiation to 74 sites in the extremities in a palliative radiation clinic between January 2009 and January 2017. Descriptive statistical analyses were performed. Results Only 2 patients required a second surgery (2.7%) at 9 and 10months after postoperative radiation. Increase in pain requiring re-irradiation was reported in 7 patients (9.5%), at a median time of 9.3months after the delivery of radiation. Of the 47 patients who had radiological imaging available post-radiation, local progression of bone metastases was seen in 8 patients (17.0%) and displacement of the prosthesis in 1 patient (2.1%). Conclusion Rates of prosthesis displacement and progression of bone metastases at site of surgery were low after postoperative radiation. There were few incidences of second surgery and re-irradiation observed in the cohort. These findings provide support for the benefit of postoperative radiation.
- Published
- 2017
9. An update in symptom clusters using the Edmonton Symptom Assessment System in a palliative radiotherapy clinic
- Author
-
Liying Zhang, Vithusha Ganesh, Cyril Danjoux, Carlo DeAngelis, Elizabeth Barnes, Edward Chow, Matthew K. Hwang, May Tsao, Rachel McDonald, Leigha Rowbottom, Pearl Zaki, Bo Angela Wan, Ronald Chow, Nicholas Lao, Leah Drost, and Stephanie Chan
- Subjects
Adult ,Male ,medicine.medical_specialty ,Nausea ,Symptom assessment ,03 medical and health sciences ,0302 clinical medicine ,Quality of life ,Palliative radiotherapy ,Internal medicine ,medicine ,Cluster (physics) ,Humans ,030212 general & internal medicine ,Depression (differential diagnoses) ,Aged ,Aged, 80 and over ,Radiotherapy ,business.industry ,Palliative Care ,Middle Aged ,Exploratory factor analysis ,Oncology ,030220 oncology & carcinogenesis ,Quality of Life ,Physical therapy ,Anxiety ,Female ,Symptom Assessment ,medicine.symptom ,business - Abstract
To identify symptom clusters in advanced cancer patients attending a palliative radiotherapy clinic using the Edmonton Symptom Assessment System (ESAS). Principal component analysis (PCA), exploratory factor analysis (EFA), and hierarchical cluster analysis (HCA) were used to identify symptom clusters among the nine ESAS items using scores from each patient’s first visit. ESAS scores from 182 patients were analyzed. The PCA identified three symptom clusters (cluster 1: depression-anxiety-well-being, cluster 2: pain-tiredness-drowsiness, cluster 3: nausea-dyspnea-loss of appetite). The EFA identified two clusters (cluster 1: tiredness-drowsiness-loss of appetite-well-being-pain-nausea-dyspnea, cluster 2: depression-anxiety). The HCA identified three clusters similar to the PCA with an exception of the loss of appetite item being classified under cluster 1 rather than 3. Two to three symptom clusters were identified using three analytical methods, with similar patterns reported in the literature. Particular groups of items co-occurred consistently across all three analyses: depression and anxiety; nausea and dyspnea; as well as pain, tiredness, and drowsiness. Three similar symptom clusters were identified in our patient population using the PCA and HCA; whereas, the EFA produced two clusters: one physical and one psychological cluster. Given the implications of symptom clusters in the management of quality of life, clinicians should be aware of these clusters to aid in the palliative treatment of patients.
- Published
- 2017
10. Thermal Therapy With a Fully Electronically Steerable HIFU Phased Array Using Ultrasound Guidance and Local Harmonic Motion Monitoring
- Author
-
Yuexi Huang, Benjamin B. C. Lucht, Bo Angela Wan, G.J. Czarnota, Vithusha Ganesh, Caitlin Yee, Edward Chow, Erin Wong, Pegah Aslani, Elizabeth David, Leah Drost, Kullervo Hynynen, and Samuel T. Gunaseelan
- Subjects
business.industry ,Phased array ,Swine ,Hand held ,Ultrasound ,Biomedical Engineering ,Thermal therapy ,Pilot Projects ,Focused ultrasound surgery ,Ultrasound guidance ,Motion ,Transducer ,Medicine ,Animals ,High-Intensity Focused Ultrasound Ablation ,Humans ,Monitoring methods ,business ,Biomedical engineering ,Ultrasonography - Abstract
The method of localized harmonic motion (LHM) monitoring has been proposed as an ultrasound-based monitoring technique for in vivo real-time ultrasound-guidance during thermal surgery. Objective: The focus of this paper is to study the performance of LHM monitoring in vivo in order to assess the tissue coagulation during ultrasound surgery of bone metastases. This is done through a pre-clinical study on large scale animals (pigs) as well as a first-in-human pilot study, using a hand held ultrasound-guided HIFU phased array. Methods: A flat, fully steerable HIFU phased array system (1024 elements, 100 mm diameter, 516 kHz), in combination with a co-aligned 64 element imaging system, is used to perform thermal surgery and monitor tissue coagulation using the LHM technique. The in vivo experiments are conducted using thirteen animals, followed by a first-in-human pilot study in which nine patients are enrolled. Results: The pre-clinical results show that the LHM monitoring method is able to detect about 80% of the observed coagulated tissue volumes visible in dissection. In the pilot study, six out of nine patients have durable pain reduction with good correlation observed from LHM detections. Conclusion: In general, the results suggest that the LHM monitoring performance is promising in detecting thermal tissue coagulation during focused ultrasound surgery in tissues close to the bone. Significance: The LHM technique can offer a very accessible and cost-efficient monitoring solution during ultrasound surgery within a clinical setting.
- Published
- 2019
11. Position of Appetite and Nausea in Symptom Clusters in Palliative Radiation Therapy
- Author
-
Edward Chow, Selina Chow, Akanksha Kulshreshtha, Carlo DeAngelis, Vithusha Ganesh, Caitlin Yee, and Henry Lam
- Subjects
medicine.medical_specialty ,Position (obstetrics) ,Palliative Radiation Therapy ,Nausea ,business.industry ,media_common.quotation_subject ,medicine ,Physical therapy ,Appetite ,medicine.symptom ,Intensive care medicine ,business ,media_common - Published
- 2019
12. Ultrasound-Guided Focused Ultrasound Treatment for Painful Bone Metastases: A Pilot Study
- Author
-
Kullervo Hynynen, Leah Drost, Elizabeth David, Yuexi Huang, Caitlin Yee, Bo Angela Wan, Vithusha Ganesh, Erin Wong, Edward Chow, Benjamin Lucht, and Gregory J. Czarnota
- Subjects
Adult ,Male ,medicine.medical_specialty ,Acoustics and Ultrasonics ,medicine.medical_treatment ,Analgesic ,Biophysics ,Pain relief ,Bone Neoplasms ,Pilot Projects ,Focused ultrasound ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Pain Management ,Radiology, Nuclear Medicine and imaging ,Aged ,Aged, 80 and over ,Radiological and Ultrasound Technology ,medicine.diagnostic_test ,business.industry ,Ultrasound ,Palliative Care ,Magnetic resonance imaging ,Cancer Pain ,Middle Aged ,High-intensity focused ultrasound ,Ultrasound guided ,Tolerability ,030220 oncology & carcinogenesis ,Quality of Life ,High-Intensity Focused Ultrasound Ablation ,Female ,Radiology ,business - Abstract
Focused ultrasound (FUS) for palliation of bone metastases has typically been performed under magnetic resonance guidance. To address limitations of this approach, this pilot study evaluated a stand-alone, portable FUS device guided by diagnostic ultrasound alone (ultrasound [US]-guided FUS). Nine patients were treated; safety and efficacy were assessed for 10 d after the procedure, and medical charts were evaluated to assess durability of pain response. The procedure was safe and tolerable, with four patients reporting minor skin-related irritations. Average pain score decreased from 6.9 at baseline to 3.2 at day 10; analgesic use on average also decreased from baseline to day 10. Six patients had durable pain relief as assessed after the follow-up period. Our study provides evidence that US-guided FUS is a safe, tolerable and versatile procedure. It appears to be effective in achieving durable pain response in patients with painful bone metastases. Further research is required to refine the technology and optimize its efficacy.
- Published
- 2019
13. The incidence of neuropathic pain in bone metastases patients referred for palliative radiotherapy
- Author
-
May Tsao, Liying Zhang, Cyril Danjoux, Ronald Chow, Vithusha Ganesh, Carlo DeAngelis, Elizabeth Barnes, Selina Chow, Breanne Lechner, Sherlyn Vuong, and Edward Chow
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Population ,Analgesic ,Bone Neoplasms ,03 medical and health sciences ,0302 clinical medicine ,Surveys and Questionnaires ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Prospective Studies ,Medical prescription ,education ,Prospective cohort study ,Pelvis ,Aged ,Pain Measurement ,education.field_of_study ,business.industry ,Incidence ,Incidence (epidemiology) ,Hematology ,Middle Aged ,Surgery ,Radiation therapy ,Cross-Sectional Studies ,medicine.anatomical_structure ,Oncology ,030220 oncology & carcinogenesis ,Neuropathic pain ,Neuralgia ,Female ,Dose Fractionation, Radiation ,Self Report ,business ,030217 neurology & neurosurgery - Abstract
Background and purpose To estimate the prevalence of neuropathic pain in patients with symptomatic bone metastases referred for palliative radiotherapy. Material and methods A prospective study of patients with symptomatic bone metastases was conducted. Patients referred for palliative radiotherapy completed the Self-Reported Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) questionnaire to assess for neuropathic pain. Patient demographics, medication use, and radiotherapy prescribed were collected. Statistical approaches to identify relationships between the presence of neuropathic and other patient factors were conducted. Results 62 patients completed the S-LANSS and 16 (25.8%) patients had a score suggesting neuropathic pain. Fifty-nine (95.2%) patients received radiotherapy with total of 81 sites treated, the most common sites were spine and pelvis. No statistically significant difference in fractionation was found between patients with and without neuropathic pain. Of the 16 patients with neuropathic pain, only 2 were receiving a neuropathic specific analgesic. No significant difference between demographic factors or radiation treatments between patients with and without neuropathic pain was found. There was no significant difference in worst pain score between these two groups. Conclusions Pain with neuropathic features remains prevalent in a population of patients referred for palliative radiotherapy. More frequent prescription of pain medications targeting neuropathic pain may be warranted in this patient population.
- Published
- 2016
14. Response to: The Survival Time of 8376 Male Breast Cancer Patients
- Author
-
L. Zhang, F.-I. Lu, Eileen Rakovitch, Bo Angela Wan, Justin Lee, Vithusha Ganesh, Edward Chow, Danny Vesprini, Philomena Sousa, Andrea Eisen, Justin Lorentz, H. Lam, Caitlin Yee, and Leah Drost
- Subjects
Oncology ,Male ,medicine.medical_specialty ,business.industry ,Breast Neoplasms ,medicine.disease ,Breast Neoplasms, Male ,Text mining ,Treatment Outcome ,Male breast cancer ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,business ,Retrospective Studies - Published
- 2018
15. Gender and age make no difference in the re-irradiation of painful bone metastases: A secondary analysis of the NCIC CTG SC.20 randomized trial
- Author
-
Ronald Chow, Liting Zhu, Yvette M. van der Linden, Keyue Ding, William F. Demas, Peter Hoskin, Ralph M. Meyer, Scott Babington, Michael Brundage, Jackson S.Y. Wu, Rebecca Wong, Manouk van Acht, Rinus Wanders, Carolyn F. Wilson, Edward Chow, William F. Hartsell, Abdenour Nabid, Vithusha Ganesh, Daniel E. Roos, Radiation Oncology, RS: GROW - R3 - Innovative Cancer Diagnostics & Therapy, and Radiotherapie
- Subjects
Male ,medicine.medical_treatment ,law.invention ,0302 clinical medicine ,Quality of life ,Randomized controlled trial ,law ,QUALITY-OF-LIFE ,Medicine ,030212 general & internal medicine ,Practice Patterns, Physicians' ,Pain Measurement ,Pain response ,Palliative Care ,Age Factors ,Hematology ,Middle Aged ,Oncology ,030220 oncology & carcinogenesis ,Female ,CLINICAL-TRIALS ,medicine.medical_specialty ,SEX-DIFFERENCES ,UNITED-STATES ,Bone Neoplasms ,PALLIATIVE RADIOTHERAPY ,03 medical and health sciences ,Sex Factors ,Age ,RADIATION-THERAPY ,MANAGEMENT ,Humans ,Radiology, Nuclear Medicine and imaging ,Patient Reported Outcome Measures ,Brief Pain Inventory ,Aged ,BARRIERS ,Radiotherapy ,business.industry ,Bone metastases ,Cancer ,Gender ,medicine.disease ,CANCER PAIN ,Clinical trial ,Radiation therapy ,Mood ,Physical therapy ,Re-irradiation ,business ,Cancer pain ,CONSENSUS - Abstract
Background and purpose: Patient's gender and age may influence physicians in prescribing palliative radiotherapy. The purpose of this secondary analysis of the National Cancer Institute of Canada Clinical Trials Group Symptom Control Trial SC.20 was to explore the gender and age differences in pain and patient reported outcomes in cancer patients with bone metastases undergoing re-irradiation.Materials and methods: Response to radiation was evaluated using the International Bone Metastases Consensus Endpoint Definitions. Patients completed the Brief Pain Inventory (BPI) and European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (00) before and 2 months after re-irradiation.Results: A total of 847 patients were analyzed. At baseline, men had more dyspnea, and mild pain. Older patients consumed less analgesic. More women reported clinically significant improvement in mood and enjoyment of life in the BPI after radiation. Similarly, younger patients reported better improvement in enjoyment of life. There were no significant gender or age differences in overall survival, response to radiation, or in 00 scores at 2 months.Conclusion: Similar benefit in terms of pain relief was observed across all patient groups. Cancer patients with bone metastases should be offered palliative re-irradiation irrespective of gender or age. Trial Registration: NCT00080912; https://clinicaltrials.gov/ct2/show/NCT00080912. (C) 2017 Elsevier B.V. All rights reserved. Radiotherapy and Oncology 126 (2018) 541-546
- Published
- 2018
16. Symptom Control
- Author
-
Vithusha Ganesh, Leila Malek, Carlo DeAngelis, and Edward Chow
- Published
- 2018
17. Impact of radiation-induced nausea and vomiting on quality of life
- Author
-
Vithusha Ganesh, Edward Chow, Bo Angela Wan, Mark Pasetka, Liying Zhang, Leah Drost, Carlo DeAngelis, Elizabeth Barnes, May Tsao, and Caitlin Yee
- Subjects
Adult ,Male ,medicine.medical_specialty ,Multivariate analysis ,Side effect ,Nausea ,Vomiting ,Pain medicine ,Radiation induced ,03 medical and health sciences ,0302 clinical medicine ,Quality of life ,Internal medicine ,Neoplasms ,Surveys and Questionnaires ,medicine ,Humans ,030212 general & internal medicine ,Prospective Studies ,Prospective cohort study ,Radiation Injuries ,Aged ,Aged, 80 and over ,business.industry ,Induction Chemotherapy ,Middle Aged ,Oncology ,030220 oncology & carcinogenesis ,Quality of Life ,Antiemetics ,Female ,medicine.symptom ,business - Abstract
Radiotherapy-induced nausea and vomiting is a common side effect of radiotherapy. It is well-established that nausea and vomiting have a negative impact on quality of life, but the relative influence of each of symptom is infrequently reported. This study aimed to compare the effects of nausea and vomiting on quality of life in cancer patients receiving palliative radiotherapy. The Functional Living Index-Emesis (FLIE) is a quality of life questionnaire developed in the chemotherapy-induced nausea and vomiting setting. The FLIE consists of 18 questions, half of which address nausea and half of which address vomiting. Three prospective studies on the efficacy of various anti-emetic medications conducted at our center used the FLIE to assess radiotherapy-induced nausea and vomiting at various time points during and after palliative radiotherapy. FLIE data from these three studies were combined for the present analysis. Univariate and multivariate analyses were conducted to assess the relationships between nausea and vomiting, time of FLIE completion, and patient-reported quality of life. Nausea and vomiting scores both decreased patients’ quality of life. Multivariate modeling showed that both symptoms significantly influenced patients’ ability to enjoy meals. Nausea was also associated with increased hardship for the patient, while vomiting imposed more difficulty on the patients’ loved ones. Nausea and vomiting both significantly influence quality of life. Nausea seems to impact the patient more directly, whereas vomiting affects those closest to the patient.
- Published
- 2017
18. A retrospective review of phyllodes tumours of the breast: A single institution experience
- Author
-
Edward Chow, Philomena Sousa, Bo Angela Wan, Justin Lee, Eileen Rakovitch, Caitlin Yee, Elzbieta Slodkowska, Danny Vesprini, Liying Zhang, Vithusha Ganesh, Henry Lam, K. Liang Zeng, and Leah Drost
- Subjects
Adult ,medicine.medical_specialty ,medicine.medical_treatment ,Breast Neoplasms ,Disease ,030230 surgery ,Mastectomy, Segmental ,Disease-Free Survival ,03 medical and health sciences ,Necrosis ,0302 clinical medicine ,Phyllodes Tumor ,Phyllodes tumours ,Breast-conserving surgery ,medicine ,Humans ,Cumulative incidence ,Breast ,Mastectomy ,Retrospective Studies ,business.industry ,Incidence (epidemiology) ,Incidence ,Phyllodes tumor ,Margins of Excision ,Retrospective cohort study ,General Medicine ,Middle Aged ,medicine.disease ,Prognosis ,030220 oncology & carcinogenesis ,Surgery ,Female ,Radiology ,Neoplasm Recurrence, Local ,business - Abstract
Background Phyllodes tumours are rare and histologically diverse, posing challenges in prognosis and treatment. Due to their rarity, they have seldom been studied. Purpose The purpose was to investigate clinical practices in the management of phyllodes tumours, as well as patient outcomes to contribute to the limited body of knowledge surrounding these tumours. Methods A retrospective review was conducted on all patients with phyllodes tumours at a single institution. Descriptive analyses were conducted on demographic, disease and treatment (breast-conserving surgery, mastectomy, surgical re-excision, adjuvant/palliative radiation, palliative chemotherapy) information. Overall and disease-free survivals were analyzed, and the cumulative incidence of recurrence and metastases was compared. Results 79 patients with phyllodes tumours of the breast were included in the study. Tumours were classified as malignant, borderline, or benign in 67.1%, 21.5%, and 11.4% of patients, respectively. There were no statistically significant differences in overall or disease-free survival between patients with benign, borderline or malignant disease. Only patients with malignant disease developed recurrence or metastases. Those with malignant disease who received mastectomies had a lower 10-year cumulative incidence of recurrence; however this was not statistically significant (p = 0.69). All patients had negative surgical margins due to a re-excision or mastectomy following margin-positive breast conserving surgery. Of all risk factors assessed, necrosis was significantly associated with increased incidence of recurrence (local or distant) in patients with malignant disease (p = 0.03). Conclusion The presence of tumour necrosis is a significant negative prognostic factor. Breast-conserving surgery may be adequate in providing local control, given negative surgical margins.
- Published
- 2017
19. Does gender affect self-perceived pain in cancer patients? -A meta-analysis
- Author
-
Marko Popovic, Leila Malek, Carlo DeAngelis, Edward Chow, Michael Lam, Vithusha Ganesh, Henry Lam, Bo Angela Wan, Yusuf Ahmed, and Milica Milakovic
- Subjects
Male ,medicine.medical_specialty ,03 medical and health sciences ,0302 clinical medicine ,Rating scale ,0502 economics and business ,medicine ,Humans ,Brief Pain Inventory ,Pain Measurement ,Advanced and Specialized Nursing ,Sex Characteristics ,business.industry ,05 social sciences ,Cancer ,Pain Perception ,Cancer Pain ,Middle Aged ,medicine.disease ,Confidence interval ,Self Concept ,Anesthesiology and Pain Medicine ,030220 oncology & carcinogenesis ,Meta-analysis ,Etiology ,Physical therapy ,050211 marketing ,Observational study ,Female ,business ,Cancer pain - Abstract
Background: Pain is reported in approximately 50–70% of cancer patients. Studies on gender differences in perceived pain generally report lower pain thresholds and increased pain prevalence in women, which may be attributed to gender-specific behaviors, stereotypes, and unknown etiological factors. There are sparse and inconclusive results on gender differences in self-perceived pain in the cancer setting. The aim of this article was to examine the effect of gender on baseline perceived pain intensity in cancer patients through a meta-analysis. Methods: A literature search was conducted using Ovid MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials [1947–2016] to identify observational studies and controlled trials that reported on gender-specific pain intensity in cancer patients. Using random-effects modeling, weighted mean differences and 95% confidence intervals (CI) were used to estimate the effect of gender on pain severity in cancer patients. A P value of less than 0.05 was considered statistically significant. Results: Of the 1,911 search results reviewed, 13 studies were included. The weighted mean difference (95% CI) in pain intensity was as follows: −0.26 (95% CI: −0.57 to 0.04, P=0.09) for the 0–10 Numerical Rating Scale (NRS) group (n=3,752, 9 studies). When restricted to only patients with advanced cancer, the weighted mean difference was −0.08 (95% CI: −0.36 to 0.20, P=0.58) (n=2,762, 4 studies). The weighted mean difference in the Brief Pain Inventory scores between males and females was 0.03 (95% CI: −1.23 to 1.29, P=0.96) (n=521, 4 studies). Conclusions: Baseline perceived pain intensity in cancer patients did not significantly differ based on gender.
- Published
- 2017
20. Do patients receiving pelvic radiation and anti-emetics experience diarrhea and/or constipation?
- Author
-
Mark Pasetka, Edward Chow, Hans Chung, Carlo DeAngelis, Elizabeth Barnes, Vithusha Ganesh, May Tsao, Leah Drost, and Bo Angela Wan
- Subjects
Diarrhea ,Male ,medicine.medical_specialty ,Palliative care ,Constipation ,Nausea ,Quality of life ,Internal medicine ,medicine ,Radiation Enteritis ,Humans ,Aged ,Advanced and Specialized Nursing ,business.industry ,Palliative Care ,Prostatic Neoplasms ,Surgery ,Anesthesiology and Pain Medicine ,medicine.anatomical_structure ,Urinary Bladder Neoplasms ,Vomiting ,Quality of Life ,Abdomen ,Antiemetics ,Female ,medicine.symptom ,business - Abstract
Background: Pelvic radiation may cause radiation enteritis, which commonly manifests as diarrhea. Radiation to the abdomen or pelvis may also cause radiation-induced nausea and vomiting (RINV) which is often treated with anti-emetics such as serotonin (5-HT3) receptor antagonists (RA). However, a common side effect of these anti-emetic medications is constipation. Both diarrhea and constipation can have a significant impact on patient quality of life (QOL). The objective of this study was to assess the prevalence of diarrhea and constipation in patients receiving pelvic radiation and anti-emetics. Methods: Patients undergoing pelvic radiation between January 2011 and March 2017 at Sunnybrook Odette Cancer Centre were enrolled in three prospective clinical trials studying the efficacy of various anti-emetics for RINV prophylaxis. Patients completed QOL questionnaires which included a single question about severity of constipation at baseline, day 5 and 10 during radiation if applicable, and day 5 and 10 after completion of radiation; severity was measured on a 4-point Likert scale ranging from 1= “not at all” to 4= “very much”. Patients also recorded severity of diarrhea throughout baseline, treatment, and 10 days follow-up via daily diaries; responses were qualitative ranging from “no diarrhea” to “severe diarrhea” on a 4-point scale. Results: Fifty-nine patients received pelvic radiation across the three trials. The average constipation score at baseline was 1.69 [standard deviation (SD) 0.93], and increased up to 2.33 (SD 1.03) at day 10 during treatment. Following treatment, the average score decreased to 1.61 (SD 0.80) at day 10 follow-up with the majority of patients reporting no constipation at this time (57.7%). The average diarrhea score at baseline was 1.03 (SD 0.18) and remained stable throughout treatment and follow-up. A vast majority of patients reported no diarrhea after day 10 follow-up (96.4%). Conclusions: Constipation was more prevalent than diarrhea during radiation treatment and up to day 10 after radiation to the pelvis. Approximately 42% of patients will have constipation on day 10 post radiation. Further research is needed to assess the causes of constipation including analgesics, and the effect on QOL during and shortly after palliative radiation to the pelvis.
- Published
- 2017
21. Attendance of older patients with bone metastases at a multidisciplinary bone metastases clinic: an 8-year experience
- Author
-
Michael Ford, Vithusha Ganesh, Albert Yee, Joel S. Finkelstein, Leigha Rowbottom, Bo Angela Wan, Leah Drost, Selina Chow, Edward Chow, and Elizabeth David
- Subjects
Adult ,Male ,medicine.medical_specialty ,Referral ,Bone Neoplasms ,Older patients ,Internal medicine ,Radiation oncology ,medicine ,Humans ,Karnofsky Performance Status ,Neoplasm Metastasis ,Referral and Consultation ,Aged ,Advanced and Specialized Nursing ,Aged, 80 and over ,Ontario ,Patient Care Team ,medicine.diagnostic_test ,business.industry ,Palliative Care ,Attendance ,Interventional radiology ,Middle Aged ,Primary cancer ,Anesthesiology and Pain Medicine ,Orthopedic surgery ,Physical therapy ,Patient Compliance ,Female ,business - Abstract
Background: Bone metastases clinic (BMC) is a multidisciplinary clinic where patients with bony metastases are assessed in conjunction by orthopedic surgery, radiation oncology, interventional radiology, and palliative medicine teams. The objective of the study was to determine the number of older adult (OA) referrals made to BMC and to examine their case dispositions. Methods: Patients who were referred to the BMC from 2007 to 2015 were included in the study. Demographic information including gender, age, Karnofsky Performance Status (KPS), primary cancer site and reason for referral, as well as case dispositions were recorded for each patient. The proportion of OA attendance was calculated for each year from the total number of patient visits. OA attendance was defined as individuals ≥65 years of age who attended the BMC, and non-OA patients were those Results: A total of 551 patients were included with a median age of 64 years. The median KPS was 70 for OA and 80 for non-OA patients. OA attendance ranged per year from 42.5% to 58.7%. 14.1% of non-OA and 10.9% of OA patients were offered surgery. 62 patients in both cohorts (22.6% of OA and 22.4% of non-OA patients) were offered palliative radiation. Conclusions: From 2007 to 2015, OA patients comprised a significant proportion of referrals to the BMC. Younger patients were offered surgery slightly more often when compared to OA patients. Age did not appear to be a precluding factor for BMC referral or a deterrent in treatments offered.
- Published
- 2017
22. A review of patterns of practice and clinical guidelines in the palliative radiation treatment of uncomplicated bone metastases
- Author
-
Ronald Chow, Henry Lam, Bo Angela Wan, Carlo DeAngelis, Stephanie Chan, Leah Drost, Vithusha Ganesh, Srinivas Raman, Edward Chow, and Peter Hoskin
- Subjects
medicine.medical_specialty ,Palliative care ,Alternative medicine ,Bone Neoplasms ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,030212 general & internal medicine ,Practice Patterns, Physicians' ,Intensive care medicine ,Contraindication ,Patient factors ,Randomized Controlled Trials as Topic ,Modalities ,Performance status ,business.industry ,Palliative Care ,Hematology ,Single fraction ,Surgery ,Fractures, Spontaneous ,Oncology ,030220 oncology & carcinogenesis ,Practice Guidelines as Topic ,Palliative radiation ,business - Abstract
Background and purpose Single fraction radiation treatment (SFRT) is recommended for its equivalence to multiple-fraction (MF) RT in the palliation of uncomplicated bone metastases (BM). However, adoption of SFRT has been slow. Materials and methods Literature searches for studies published following 2014 were conducted using online repositories of gray literature, Ovid MEDLINE, Embase and Embase Classic, and the Cochrane Central Register of Controlled Trials databases. Results A total of 32 articles detailing patterns of practice and clinical practice guidelines were included for final synthesis. The majority of organizations have released high level recommendations for SFRT use in treatment of uncomplicated BM, based on evidence of non-inferiority to MFRT. There are key differences between guidelines, such as varying strengths of recommendation for SFRT use over MFRT; contraindication in vertebral sites for SFRT; and risk estimation of pathologic fractures after SFRT. Differences in guidelines may be influenced by committee composition and organization mandate. Differences in patterns of practice may be influenced by individual center policies, payment modalities and consideration of patient factors such as age, prognosis, and performance status. Conclusion Although there is some variation between groups, the majority of guidelines recommend use of SFRT and others consider it to be a reasonable alternative to MFRT.
- Published
- 2017
23. Papillary Carcinoma of the Male Breast: A Case Series
- Author
-
Caitlin, Yee, primary, Bo Angela, Wan, additional, Leah, Drost, additional, Justin, Lee, additional, Vithusha, Ganesh, additional, Akanksha, Kulshreshtha, additional, Danny, Vesprini, additional, Henry, Lam, additional, and Edward, Chow, additional
- Published
- 2017
- Full Text
- View/download PDF
24. Not All Lumps in Male Breast Referred to the Cancer Centre are Cancerous: A Single Institution Review
- Author
-
Bo Angela, Wan, primary, Caitlin, Yee, additional, Vithusha, Ganesh, additional, Philomena, Sousa, additional, Leah, Drost, additional, Akanksha, Kulshreshtha, additional, Justin, Lee, additional, Eileen, Rakovitch, additional, Danny, Vesprini, additional, Henry, Lam, additional, and Edward, Chow, additional
- Published
- 2017
- Full Text
- View/download PDF
25. Presentation and Diagnosis of Desmoid Tumours (Fibromatosis) in the Male Breast: A Case Report
- Author
-
Akanksha, Kulshreshtha, primary, Bo Angela, Wan, additional, Leah, Drost, additional, Caitlin, Yee, additional, Vithusha, Ganesh, additional, Justin, Lee, additional, Danny, Vesprini, additional, Henry, Lam, additional, and Edward, Chow, additional
- Published
- 2017
- Full Text
- View/download PDF
26. Apocrine Carcinoma of the Male Breast: A Case Report
- Author
-
Caitlin, Yee, primary, Bo Angela, Wan, additional, Leah, Drost, additional, Justin, Lee, additional, Vithusha, Ganesh, additional, Akanksha, Kulshreshtha, additional, Danny, Vesprini, additional, Henry, Lam, additional, and Edward, Chow, additional
- Published
- 2017
- Full Text
- View/download PDF
27. Prophylaxis of radiation-induced nausea and vomiting: a systematic review and meta-analysis of randomized controlled trials
- Author
-
Srinivas Raman, Sherlyn Vuong, Kam Hung Wong, Vithusha Ganesh, Joanne M. van der Velden, Rachel McDonald, J. P. Maarten Burbach, Marko Popovic, Henry Lam, Wing Sum Kenneth Li, Edward Chow, Roger K.C. Ngan, and Carlo DeAngelis
- Subjects
Metoclopramide ,Nausea ,Vomiting ,Placebo ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,5-HT3 Receptor Antagonist ,Randomized controlled trial ,law ,medicine ,Humans ,030212 general & internal medicine ,Adverse effect ,Randomized Controlled Trials as Topic ,Advanced and Specialized Nursing ,Radiotherapy ,business.industry ,Lorazepam ,Anesthesiology and Pain Medicine ,030220 oncology & carcinogenesis ,Anesthesia ,Antiemetics ,medicine.symptom ,business ,medicine.drug - Abstract
Background: The aim of this article was to systematically review the efficacy and safety of various antiemetics in prophylaxis of radiation-induced nausea and vomiting (RINV). Methods: A literature search of Ovid MEDLINE, EMBASE and Cochrane CENTRAL was performed to identify randomized controlled trials (RCTs) that evaluated the efficacy of prophylaxis for RINV in patients receiving radiotherapy to abdomen/pelvis, including total body irradiation (TBI). Primary endpoints were complete control of nausea and complete control of vomiting during acute and delayed phases. Secondary endpoints included use of rescue medication, quality of life (QoL) and incidence of adverse events. Results: Seventeen RCTs were identified. Among patients receiving radiotherapy to abdomen/pelvis, our meta-analysis showed that prophylaxis with a 5-hydroxytryptamine-3 receptor antagonist (5HT3 RA) was significantly more efficacious than placebo and dopamine receptor antagonists in both complete control of vomiting [OR 0.49; 95% confidence interval (CI): 0.33–0.72 and OR 0.17; 95% CI: 0.05–0.58 respectively] and complete control of nausea (OR 0.43; 95% CI: 0.26–0.70 and OR 0.46; 95% CI: 0.24–0.88 respectively). 5HT3 RAs were also more efficacious than rescue therapy and dopamine receptor antagonists plus dexamethasone. The addition of dexamethasone to 5HT3 RA compared to 5HT3 RA alone provides a modest improvement in prophylaxis of RINV. Among patients receiving TBI, 5HT3 RA was more effective than other agents (placebo, combination of metoclopramide, dexamethasone and lorazepam). Conclusions: 5HT3 RAs are more effective than other antiemetics for prophylaxis of RINV in patients receiving radiotherapy to abdomen/pelvis and TBI. Future RCTs should investigate the efficacy of newer agents such as substance P neurokinin 1 receptor antagonists in addition to 5HT3 RAs in prophylaxis of RINV during both acute and delayed phases.
- Published
- 2016
28. Adverse Health Outcomes Associated with Postdiagnosis Smoking in Prostate Cancer Patients: A Literature Review
- Author
-
Lisa Di Prospero, Leslie Gibson, Carlo DeAngelis, Bonnie Bristow, Vithusha Ganesh, Edward Chow, Angela Turner, Pearl Zaki, and Stephanie Chan
- Subjects
Oncology ,Biochemical recurrence ,medicine.medical_specialty ,medicine.medical_treatment ,Population ,030232 urology & nephrology ,03 medical and health sciences ,Prostate cancer ,0302 clinical medicine ,Quality of life ,Prostate ,Internal medicine ,medicine ,Radiology, Nuclear Medicine and imaging ,Adverse effect ,education ,Gynecology ,education.field_of_study ,Radiological and Ultrasound Technology ,business.industry ,medicine.disease ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Smoking cessation ,Hormone therapy ,business - Abstract
This literature review presents what is currently known about the association between postdiagnosis smoking and adverse health outcomes in prostate cancer. A literature search was conducted using Ovid Embase and Ovid MEDLINE. Information from 36 studies was summarized. There is strong evidence across the included studies of higher overall mortality and biochemical recurrence in current smokers diagnosed with prostate cancer. In addition, enhanced adverse effects following surgery, radiation, and hormone therapy have also been identified in current smokers of this population.
- Published
- 2016
29. Solitary brain metastasis from prostate cancer: a case report
- Author
-
Hany Soliman, Sherlyn Vuong, Michael Borean, Edward Chow, Rachel McDonald, Vithusha Ganesh, Arnav Agarwal, and Tasneem Barakat
- Subjects
Oncology ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Tumor resection ,Antineoplastic Agents ,Disease ,Radiosurgery ,03 medical and health sciences ,Prostate cancer ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Favorable outcome ,Aged ,Advanced and Specialized Nursing ,business.industry ,Brain Neoplasms ,Cancer ,Prostatic Neoplasms ,Androgen Antagonists ,medicine.disease ,Combined Modality Therapy ,Radiation therapy ,Anesthesiology and Pain Medicine ,030220 oncology & carcinogenesis ,business ,Adjuvant ,030217 neurology & neurosurgery ,Craniotomy ,Brain metastasis - Abstract
Brain metastases arising from prostate cancer are exceedingly rare and typically occur late in the course of the disease. Most patients have widespread metastatic disease before developing brain metastases from prostate cancer. We report the case of a 67-year-old male with prostate cancer presenting with an isolated symptomatic brain metastasis. Aggressive treatment of the metastatic site included tumor resection and adjuvant stereotactic radiation treatment (RT) to the surgical bed, resulting in a favorable outcome.
- Published
- 2016
30. Comparison of the FACT-C, EORTC QLQ-CR38, and QLQ-CR29 quality of life questionnaires for patients with colorectal cancer: a literature review
- Author
-
Michael Borean, Edward Chow, Leigha Rowbottom, Vithusha Ganesh, Andrew Bottomley, Tasneem Barakat, Carlo DeAngelis, Arnav Agarwal, Henry Lam, Rachel McDonald, Stephanie Chan, David Cella, Sherlyn Vuong, and Marko Popovic
- Subjects
Oncology ,Male ,medicine.medical_specialty ,Ovid medline ,Colorectal cancer ,Likert scale ,03 medical and health sciences ,0302 clinical medicine ,Cronbach's alpha ,Quality of life ,Internal consistency ,Internal medicine ,Surveys and Questionnaires ,otorhinolaryngologic diseases ,medicine ,Humans ,030212 general & internal medicine ,Reliability (statistics) ,business.industry ,Cancer ,Reproducibility of Results ,social sciences ,medicine.disease ,humanities ,030220 oncology & carcinogenesis ,Quality of Life ,Female ,business ,Colorectal Neoplasms ,Clinical psychology - Abstract
The purpose of this review was to compare the development, characteristics, validity, and reliability of three widely used quality of life (QOL) assessment tools used in colorectal cancer (CRC) patients: the Functional Assessment of Cancer Therapy-Colorectal (FACT-C), the European Organization for Research and Treatment of Cancer Quality of Life (EORTC) Quality of Life Questionnaire Colorectal Cancer Module (QLQ-CR38) and its successor, the QLQ-CR29. A literature search was conducted using Ovid EMBASE and EMBASE Classic (1996–2015 Week 39), Ovid MEDLINE and OLDMEDLINE (1996 September Week 4 2015), and the Cochrane Central Register of Controlled Trials (up to August 2015) to identify studies that discussed the FACT-C, EORTC QLQ-CR38, and QLQ-CR29 including, but not limited to, their development, characteristics, validity, and reliability. The FACT-C consists of 36 items, presented on a 5-point Likert scale, in four domains of well-being (physical, emotional, social, and functional), and the Colorectal Cancer Subscale (CCS). The physical and social well-being scales showed reasonable internal consistency (Cronbach’s alpha coefficient > 60) in all studied populations. The EORTC QLQ-CR38 (38 items) and the QLQ-CR29 (29 items) are implemented in conjunction with the core QLQ-C30 (30 items); all are presented in 4-point Likert scales. Seven scales in the QLQ-CR38 demonstrated good internal consistency (Cronbach’s alpha coefficient > 0.70). In the QLQ-CR29, three scales had a Cronbach’s alpha coefficient of less than 0.70. The FACT-C, QLQ-CR38, and QLQ-CR29 have been extensively validated. However, analysis of their characteristics, validity, and reliability suggest differing suitability in assessing QOL in specific clinical situations.
- Published
- 2016
31. A case report of bone metastases from appendiceal adenocarcinoma and a review of literature
- Author
-
Linda Probyn, Sherlyn Vuong, Vithusha Ganesh, Edward Chow, and Sydney Caskenette
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,External beam radiation ,Bone Neoplasms ,Disease ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Rare case ,Medicine ,Humans ,Pelvic Bones ,Pelvis ,Advanced and Specialized Nursing ,Chemotherapy ,business.industry ,Middle Aged ,Appendiceal Adenocarcinoma ,Rare cancer ,Adenocarcinoma, Mucinous ,Surgery ,Radiation therapy ,Anesthesiology and Pain Medicine ,medicine.anatomical_structure ,Treatment Outcome ,Appendiceal Neoplasms ,030220 oncology & carcinogenesis ,business - Abstract
Appendiceal adenocarcinoma (AA) is a rare cancer, accounting for less than 0.5% of all gastrointestinal cancers. As such, there is still debate surrounding both the nature of the disease and the roles of different treatment modalities in the care of this patient population. Metastases of AA, particularly distant metastases, have not been explored extensively in literature. As survival in optimally treated cases of AA continues to improve, clinicians may encounter previously unrealized complications of this disease or unlikely metastases at a higher frequency. We reported the rare case of a 50-year-old male with recurrent mucinous AA who developed painful pelvic bone metastases. To palliate his symptoms, the patient underwent 30 Gy of external beam radiation treatment (EBRT) in 10 fractions to the pelvis. The patient achieved a good pain response after completion of EBRT, with elimination of analgesic use one month post-treatment. This case demonstrates successful palliative management of bone metastases from a primary mucinous AA. Although there is a lack of evidence-based guidelines specific to the treatment of AA, there are a variety of therapies available [e.g., chemotherapy, cytoreductive surgery (CRS), radiation, etc.]. The use of these treatments is largely determined by prognostic factors.
- Published
- 2015
32. Comparison of the EORTC STO-22 and the FACT-Ga quality of life questionnaires for patients with gastric cancer
- Author
-
Aaron, Woo, Terence, Fu, Marko, Popovic, Edward, Chow, David, Cella, C Shun, Wong, Henry, Lam, Natalie, Pulenzas, Breanne, Lechner, Sherlyn, Vuong, Vithusha, Ganesh, and Andrew, Bottomley
- Subjects
Stomach Neoplasms ,Surveys and Questionnaires ,Quality of Life ,Humans ,Reproducibility of Results ,Self Report - Abstract
This review compares the development, characteristics, validity, and reliability of two well-known quality of life (QOL) assessment tools used in patients with gastric cancer: the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Stomach (EORTC QLQ-STO22) and the Functional Assessment of Cancer Therapy-Gastric (FACT-Ga). A literature search was conducted using MEDLINE, EMBASE, and Cochrane CENTRAL (inception to April 2015) to identify studies that discussed the development, characteristics, validity and reliability of the EORTC QLQ-STO22 or the FACT-Ga. The QLQ-STO22 was developed with collaboration with patients, healthcare professionals and literature review and was mainly field tested in European countries. Conversely, items on the FACT-Ga were generated from interviews with patients and healthcare professionals concurrently in North America and Asia. While both modules involve a 7-day recall period and use Likert scales, the QLQ-STO22 and FACT-Ga differ in terms of QOL domain focus, quantity and presentation of items, response options, and scoring. However, both tools show good internal consistency, test-retest reliability, sensitivity to change and construct validity. In addition, both questionnaires have been internationally validated within a large sample of patients undergoing a variety of treatments, thus demonstrating their cross-cultural applicability. The EORTC QLQ-STO22 and FACT-Ga are both valid and reliable tools with unique strengths and weaknesses. Selection between instruments should consider specific patient characteristics and goals of the study.
- Published
- 2015
33. Palliative treatment of metastatic phyllodes tumors: a case series
- Author
-
Justin Lee, Bo Angela Wan, Edward Chow, Elzbieta Slodkowska, Vithusha Ganesh, K. Liang Zeng, Eileen Rakovitch, Philomena Sousa, Danny Vesprini, and Caitlin Yee
- Subjects
medicine.medical_specialty ,Chemotherapy ,Lung ,business.industry ,medicine.medical_treatment ,Soft tissue ,Case Report ,General Medicine ,Thigh ,Radiosurgery ,Radiation therapy ,medicine.anatomical_structure ,Peritoneum ,Scalp ,medicine ,Radiology ,business - Abstract
Up to 20% of malignant phyllodes tumors (PT) metastasize, most frequently to the lungs, bone, and brain. Descriptions of metastatic PT are limited in the literature. In this series, we present three cases of malignant PT metastatic to various unusual sites including the peritoneum, soft tissue of the thigh, and scalp. All three patients initially received surgical resections, and two underwent adjuvant radiation. All three patients developed lung metastases first. Several palliative modalities were used including surgical resection, gamma-knife stereotactic radiosurgery, external beam radiation, and chemotherapy. All three patients died within 3 years of the initial diagnosis.
- Published
- 2017
34. Enteral and parenteral nutrition in cancer patients: a systematic review and meta-analysis
- Author
-
Ronald, Chow, Eduardo, Bruera, Leonard, Chiu, Selina, Chow, Nicholas, Chiu, Henry, Lam, Rachel, McDonald, Carlo, DeAngelis, Sherlyn, Vuong, Vithusha, Ganesh, and Edward, Chow
- Subjects
Infection Control ,Parenteral Nutrition ,Enteral Nutrition ,Nutritional Support ,Neoplasms ,Humans ,Protein-Energy Malnutrition ,Randomized Controlled Trials as Topic - Abstract
In cancer patients, weight loss is an ominous sign suggesting disease progression and shortened survival time. As a result, providing nutrition support for cancer patients has been proposed as a logical approach for improving clinical outcomes. Nutrition support can be given to patients through enteral nutrition (EN) or parenteral nutrition (PN). The purpose of the review was to compare the outcomes of PN and EN in cancer patients.A literature search was conducted in Ovid MEDLINE and OLDMEDLINE, Embase Classic and Embase, and Cochrane Central Register of Controlled Trials. Studies were included if over half of the patient population had cancer and reported on any of the following endpoints: the percentage of patients that experienced no infection, nutrition support complications, major complications or mortality. Risk ratios (RR) and 95% confidence intervals (CIs) using Review Manager Version 5.3 were calculated. Primary endpoints were stratified according to type of EN for subgroup analysis, grouping studies into either tube feeding (TF) or standard care (SC). Additionally, another subgroup analysis was conducted comparing studies with protein-energy malnutrition (PEM) patients and studies without PEM patients.The literature search yielded 674 articles of which 36 were included for the meta-analysis. There were no difference in the endpoints between the two study interventions except that PN resulted in more infection when compared with EN (RR =1.09, 95% CI: 1.01-1.18; P=0.03).Other than increased incidence of infection, PN has not resulted in prolonging the survival, increasing nutrition support complications, or major complications when compared with EN in cancer patients.
- Published
- 2015
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.