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Turgeman I, Benaim AR, Regev-Tsur S, Turgeman S, Abu Amna M, Badran O, Bar-Sela G. Too Much of a Good Thing: The Association of Elevated Vitamin B12 Levels and Outcomes in Patients With Cancer Treated With Immunotherapy. J Immunother 2024; 47:117-122. [PMID: 37909180 DOI: 10.1097/cji.0000000000000493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 10/03/2023] [Indexed: 11/02/2023]
Abstract
Metabolic pathways may regulate responses to cancer immunotherapy (IO). Due to its immunomodulatory properties, we sought to examine the association between serum vitamin B12 (VitB12) and survival in individuals with cancer treated with immune checkpoint inhibitors, compared with biological and chemotherapy. We collected data on patients with advanced cancer initiating intravenous antineoplastic treatment and a concomitant VitB12 measurement (elevated: >820 ng/L), between January 2010 and January 2022. Patients on IO and other regimens (control) were compared using the Mann-Whitney test for continuous variables, χ 2 test or Fisher test for categorical variables, and multivariate Cox regression models assessed the effect of VitB12 on overall survival and progression-free survival, adjusting for confounders. Patient groups (control: n = 408; IO: n = 93) were balanced for the treatment line and VitB12 (elevated 29.9% vs 23.7%; mean 762.4 vs 687.6 ng/L). In multivariate analysis, overall survival in all patients was negatively associated with VitB12 [control: hazard ratio (HR): 1.4, 95% CI: 1.01-1.96, P = 0.04, false discovery rate (FDR): 0.069; IO: HR: 2.74 as sum of linear baseline and interaction effects, log scale], age (HR: 1.03, 95% CI: 1.02-1.04, P < 0.01), male sex (HR: 0.66, 95% CI: 0.50-0.88, P < 0.01), and neutrophil-to-lymphocyte ratio (HR: 1.05, 95% CI: 0.48-0.99, P = 0.01). However, VitB12 was significantly negatively associated with progression-free survival only in the IO group ( P < 0.001, FDR < 0.001, calculated HR: 8.34; biological treatment P = 0.08; FDR: 0.111; neutrophil-to-lymphocyte ratio, P = 0.07; FDR: 0.09). Taken together, elevated VitB12 was a negative predictor for outcomes on IO, independently of other known prognostic factors. Further research is needed to elucidate the immune-metabolic interplay and its interaction with the gut microbiome, as well as interventional strategies to enhance IO responses.
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Affiliation(s)
| | - Anat Reiner Benaim
- Department of Epidemiology, Biostatistics, and Community Health Sciences, School of Public Health, Ben Gurion University of the Negev, Beer Sheba
| | | | | | | | - Omar Badran
- Department of Oncology, Emek Medical Center, Afula
| | - Gil Bar-Sela
- Department of Oncology, Emek Medical Center, Afula
- Department Technion Integrated Cancer Center, Technion-Israel Institute of Technology, Haifa, Israel
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Braun IM, Bohlke K, Abrams DI, Anderson H, Balneaves LG, Bar-Sela G, Bowles DW, Chai PR, Damani A, Gupta A, Hallmeyer S, Subbiah IM, Twelves C, Wallace MS, Roeland EJ. Cannabis and Cannabinoids in Adults With Cancer: ASCO Guideline. J Clin Oncol 2024; 42:1575-1593. [PMID: 38478773 DOI: 10.1200/jco.23.02596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 12/20/2023] [Indexed: 04/28/2024] Open
Abstract
PURPOSE To guide clinicians, adults with cancer, caregivers, researchers, and oncology institutions on the medical use of cannabis and cannabinoids, including synthetic cannabinoids and herbal cannabis derivatives; single, purified cannabinoids; combinations of cannabis ingredients; and full-spectrum cannabis. METHODS A systematic literature review identified systematic reviews, randomized controlled trials (RCTs), and cohort studies on the efficacy and safety of cannabis and cannabinoids when used by adults with cancer. Outcomes of interest included antineoplastic effects, cancer treatment toxicity, symptoms, and quality of life. PubMed and the Cochrane Library were searched from database inception to January 27, 2023. ASCO convened an Expert Panel to review the evidence and formulate recommendations. RESULTS The evidence base consisted of 13 systematic reviews and five additional primary studies (four RCTs and one cohort study). The certainty of evidence for most outcomes was low or very low. RECOMMENDATIONS Cannabis and/or cannabinoid access and use by adults with cancer has outpaced the science supporting their clinical use. This guideline provides strategies for open, nonjudgmental communication between clinicians and adults with cancer about the use of cannabis and/or cannabinoids. Clinicians should recommend against using cannabis or cannabinoids as a cancer-directed treatment unless within the context of a clinical trial. Cannabis and/or cannabinoids may improve refractory, chemotherapy-induced nausea and vomiting when added to guideline-concordant antiemetic regimens. Whether cannabis and/or cannabinoids can improve other supportive care outcomes remains uncertain. This guideline also highlights the critical need for more cannabis and/or cannabinoid research.Additional information is available at www.asco.org/supportive-care-guidelines.
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Affiliation(s)
- Ilana M Braun
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Kari Bohlke
- American Society of Clinical Oncology, Alexandria, VA
| | - Donald I Abrams
- University of California San Francisco Osher Center for Integrative Health, San Francisco, CA
| | | | | | | | | | | | - Anuja Damani
- Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | | | | | | | - Chris Twelves
- University of Leeds and Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Eric J Roeland
- Oregon Health and Science University, Knight Cancer Institute, Portland, OR
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Schultz M, Baziliansky S, Mitnik I, Ulitzur N, Campisi-Pinto S, Givoli S, Bar-Sela G, Zalman D. Some differences between social work, spiritual care, and psychology: Content variance in end-of-life conversations. Palliat Support Care 2024; 22:306-313. [PMID: 37605972 DOI: 10.1017/s1478951523000652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
OBJECTIVES Within the multidisciplinary team, there can sometimes be lack of clarity as to the specific different contributions of each of the psycho-social-spiritual professionals: social workers, psychologist, and spiritual caregivers. This study examined the content of their end-of-life conversations with patients. METHODS A total of 180 patients with terminal cancer received standard multidisciplinary care, including conversations with a social worker, psychologist, and spiritual caregiver. After each patient's death, these professionals reported using a structured tool which content areas had arisen in their conversations with that patient. RESULTS Across all content areas, there were significant differences between social work and spiritual care. The difference between social work and psychology was slightly smaller but still quite large. Psychology and spiritual care were the most similar, though they still significantly differed in half the content areas. The differences persisted even among patients who spoke with more than 1 kind of professional. The 6 content areas examined proved to subdivide into 2 linked groups, where patients speaking about 1 were more likely to speak about the others. One group, "reflective" topics (inner and transpersonal resources, interpersonal relationships, one's past, and end of life), included all those topics which arose more often with spiritual caregivers or psychologists. The second group, "decision-making" topics (medical coping and life changes), was comprised of those topics which arose most commonly with social workers, bridging between the medical and personal aspects of care and helping patients navigate their new physical, psychological, and social worlds. SIGNIFICANCE OF RESULTS These findings help shed light on the differences, in practice, between patients' conversations with social workers, psychologists, and spiritual caregivers and the roles these professionals are playing; can aid in formulating individualized care plans; and strengthen the working assumption that all 3 professions contribute in unique, complementary ways to improving patients' and families' well-being.
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Affiliation(s)
- Michael Schultz
- Division of Oncology, Rambam Health Care Campus, Haifa, Israel
| | | | - Inbal Mitnik
- Division of Oncology, Rambam Health Care Campus, Haifa, Israel
| | - Nirit Ulitzur
- Division of Oncology, Rambam Health Care Campus, Haifa, Israel
| | | | - Simon Givoli
- Statistical Department, Midot Ltd., Tel Aviv, Israel
| | - Gil Bar-Sela
- Cancer Center, Emek Medical Center, Afula, Israel
- Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Daniela Zalman
- Division of Oncology, Rambam Health Care Campus, Haifa, Israel
- Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Hilwi M, Shulman K, Naroditsky I, Feld S, Gross-Cohen M, Boyango I, Soboh S, Vornicova O, Farhoud M, Singh P, Bar-Sela G, Goldberg H, Götte M, Sharrocks AD, Li Y, Sanderson RD, Ilan N, Vlodavsky I. Nuclear localization of heparanase 2 (Hpa2) attenuates breast carcinoma growth and metastasis. Cell Death Dis 2024; 15:232. [PMID: 38519456 PMCID: PMC10959965 DOI: 10.1038/s41419-024-06596-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 02/28/2024] [Accepted: 03/06/2024] [Indexed: 03/25/2024]
Abstract
Unlike the intense research effort devoted to exploring the significance of heparanase in cancer, very little attention was given to Hpa2, a close homolog of heparanase. Here, we explored the role of Hpa2 in breast cancer. Unexpectedly, we found that patients endowed with high levels of Hpa2 exhibited a higher incidence of tumor metastasis and survived less than patients with low levels of Hpa2. Immunohistochemical examination revealed that in normal breast tissue, Hpa2 localizes primarily in the cell nucleus. In striking contrast, in breast carcinoma, Hpa2 expression is not only decreased but also loses its nuclear localization and appears diffuse in the cell cytoplasm. Importantly, breast cancer patients in which nuclear localization of Hpa2 is retained exhibited reduced lymph-node metastasis, suggesting that nuclear localization of Hpa2 plays a protective role in breast cancer progression. To examine this possibility, we engineered a gene construct that directs Hpa2 to the cell nucleus (Hpa2-Nuc). Notably, overexpression of Hpa2 in breast carcinoma cells resulted in bigger tumors, whereas targeting Hpa2 to the cell nucleus attenuated tumor growth and tumor metastasis. RNAseq analysis was performed to reveal differentially expressed genes (DEG) in Hpa2-Nuc tumors vs. control. The analysis revealed, among others, decreased expression of genes associated with the hallmark of Kras, beta-catenin, and TNF-alpha (via NFkB) signaling. Our results imply that nuclear localization of Hpa2 prominently regulates gene transcription, resulting in attenuation of breast tumorigenesis. Thus, nuclear Hpa2 may be used as a predictive parameter in personalized medicine for breast cancer patients.
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Affiliation(s)
- Maram Hilwi
- Technion Integrated Cancer Center, Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | | | - Inna Naroditsky
- Departments of Pathology, Rambam Health Care Campus, Haifa, Israel
| | - Sari Feld
- Technion Integrated Cancer Center, Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Miriam Gross-Cohen
- Technion Integrated Cancer Center, Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Ilanit Boyango
- Technion Integrated Cancer Center, Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Soaad Soboh
- Technion Integrated Cancer Center, Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Olga Vornicova
- Department of Oncology, Ha'amek Medical Center, Afula, Israel
| | - Malik Farhoud
- Technion Integrated Cancer Center, Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Preeti Singh
- Technion Integrated Cancer Center, Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Gil Bar-Sela
- Technion Integrated Cancer Center, Rappaport Faculty of Medicine, Technion, Haifa, Israel
- Department of Oncology, Ha'amek Medical Center, Afula, Israel
| | | | - Martin Götte
- Department of Gynecology and Obstetrics, Münster University Hospital, Muenster, Germany
| | - Andrew D Sharrocks
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Yaoyong Li
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Ralph D Sanderson
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Neta Ilan
- Technion Integrated Cancer Center, Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Israel Vlodavsky
- Technion Integrated Cancer Center, Rappaport Faculty of Medicine, Technion, Haifa, Israel.
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5
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Ben-Arye E, Mao J, Bruera E, Samuels N, Keshet Y, Lee RT, Ben-Yehuda D, Eisenberg E, Bar-Sela G, Shvartzman P, Balneaves LG, Shani M, Ellis M, Tripathy D, Ash S, Elis A, Vaknin Z, Ofir R, Schiff E. Challenges in Implementing Guideline on Integrative Oncology and Pain: The Israeli Perspective. J Pain Symptom Manage 2024; 67:69-76. [PMID: 37769821 DOI: 10.1016/j.jpainsymman.2023.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 09/15/2023] [Accepted: 09/20/2023] [Indexed: 10/03/2023]
Abstract
CONTEXT AND OBJECTIVES To explore the feasibility of implementing the joint guideline on integrative medicine for pain management in oncology, published by the Society for Integrative Oncology (SIO) and the American Society of Clinical Oncology (ASCO), for integrative oncology (IO) services in supportive and palliative care. METHODS A qualitative research methodology was co-designed by the SIO-ASCO guideline committee, with the Society for Complementary Medicine, Israel Medical Association (IMA). A questionnaire with five open-ended questions exploring barriers and enablers to implementing the guideline was distributed to chairs and board members of nine IMA-affiliated medical societies; four deans of Israeli medical schools; and nurses from the Israeli Society for Oncology Nursing. Respondent narratives were qualitatively analyzed using ATLAS.Ti software for systematic coding. RESULTS Questionnaires were completed by 52 physicians and nurses from medical oncology, hematology, gynecological oncology, pediatric oncology, palliative medicine, pain, family medicine, internal medicine, and integrative medicine. The SIO-ASCO guidelines were endorsed by nine IMA-affiliated societies. The domains identified included the importance of guideline implementation in clinical practice; barriers and facilitators to implementation; practical aspects required for this implementation (e.g., IO training); clinical indications for referral; budget-related issues; and clinical and administrative models enabling practical implementation of the guideline. CONCLUSION We found across-the-board consensus among the nine IMA-affiliated societies supporting the current guideline. This, while identifying potential facilitators and barriers in order to address the implementation of the SIO-ASCO guideline recommendations.
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Affiliation(s)
- Eran Ben-Arye
- Integrative Oncology Program (E.B-A), The Oncology Service; Lin, Carmel, and Zebulun Medical Centers, Clalit Health Services, Haifa, Israel; Ruth and Bruch Rappaport Faculty of Medicine (E.B-A., E.E.), Technion-Israel Institute of Technology, Haifa, Israel.
| | - Jun Mao
- ASCO Guideline on Integrative Medicine for Pain Management (J.M.); Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Eduardo Bruera
- ASCO Guideline on Integrative Medicine for Pain Management (E.B.); MD Anderson Cancer Center, Houston, Texas, USA
| | - Noah Samuels
- Center for Integrative Complementary Medicine (N.S.), Shaarei Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Yael Keshet
- Department of Sociology (Y.K.), The Western Galilee College, Acco, Israel
| | - Richard T Lee
- City of Hope Comprehensive Cancer Center (R.T.L.), Duarte, California, USA
| | - Dina Ben-Yehuda
- Hadassah-Hebrew University Medical School (D.B-Y.), Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Elon Eisenberg
- Ruth and Bruch Rappaport Faculty of Medicine (E.B-A., E.E.), Technion-Israel Institute of Technology, Haifa, Israel; The Israel Pain Society (E.E.), Israel Medical Association, Israel
| | - Gil Bar-Sela
- Israeli Society of Clinical Oncology & Radiation Therapy (ISCORT) (G.B-S.), Israel Medical Association; Cancer Center, Emek Medical Center, Afula, Israel
| | - Pesach Shvartzman
- Israel Society for Palliative Medicine (P.S.), Israel Medical Association; Siaal Center for Community Research, Pain and Palliative Care Unit, Kappy and Eric Flanders National Palliative Care Resource Centre, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Lynda G Balneaves
- College of Nursing, Faculty of Health Sciences (L.G.B.), University of Manitoba, Winnipeg, Manitoba, Canada
| | - Michal Shani
- Israel Association of Family Physicians (M.S.), Israel Medical Association; Department of Family Medicine, Central District, Clalit Health Service, Rehovot, Israel; Sackler Faculty of Medicine (M.S.), Tel Aviv University, Tel Aviv, Israel
| | - Martin Ellis
- Israel Society of Hematology and Transfusion Medicine (M.E.), Israel Medical Association; Hematology Institute and Translational Hemato-Oncology Laboratory, Meir Medical Center, Israel
| | - Debu Tripathy
- Department of Breast Medical Oncology (D.T.), University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Shifra Ash
- Israeli Society of Pediatric Hematology/Oncology (S.A.), Israel Medical Association; Department of Pediatric Hematology-Oncology, Rambam Medical Center, Haifa, Israel
| | - Avishay Elis
- Israel Society of Internal Medicine (A.E), Israel Medical Association; Department of Internal Medicine "C", Beilinson Hospital, Rabin Medical Center, Petah-Tikva, Israel
| | - Zvi Vaknin
- Israeli Society of Gynecologic Oncology (Z.V.), Israel Medical Association; Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center, Zerifin, Israel; Affiliated to the Sackler Faculty of Medicine (Z.V.), Tel Aviv University, Tel Aviv, Israel
| | - Ruth Ofir
- Israeli Oncology Nursing Society (R.O.), Department of Pediatric Hematology-Oncology, Rambam Medical Center, Haifa, Israel
| | - Elad Schiff
- The Society of Complementary Medicine (E.S.), Israel Medical Association; Department of Internal Medicine & Integrative Medicine Service, Bnai-Zion Medical Center, Haifa, Israel
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Cohen M, Shamay Y, Czamanski-Cohen J, Shulman K, Keren Rosenberg S, Abu-Amna M, Turgeman I, Merkin Livshits L, Birenboim R, Dines M, Bar-Sela G. Linkage between Psychological Factors and Response to Immune Checkpoint Inhibitor Therapy: A Preliminary Study. Cells 2023; 12:2471. [PMID: 37887315 PMCID: PMC10605722 DOI: 10.3390/cells12202471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/02/2023] [Accepted: 10/11/2023] [Indexed: 10/28/2023] Open
Abstract
Substantial evidence has accumulated showing that psychological distress affects immune regulation, the response to cancer treatment, and survival. The effect of psychological parameters on the effectiveness of immune checkpoint inhibitor (ICI) treatment has not yet been studied. This preliminary study aimed to (a) examine the associations between psychological factors and responses to ICI treatment and (b) assess the associations between psychological factors and blood measures of sPD-1, sCTLA-4, and cytokines that may alter the effect of ICI treatment. The participants were 62 individuals with advanced cancer, aged 18 years or older, who were candidates for ICI treatment as a new line of treatment. The participants answered questionnaires and provided blood samples and medical data prior to the start of ICI treatment and 3 months after. Perceived health status was positively associated with better responses to ICI treatment. In the subsample of participants with biomarkers, worse health-related quality of life was associated with higher IL-6 and sCTLA-4; emotional distress and sleep difficulties were associated with higher sCTLA-4; and better perceived health was associated with lower IL-6 and TNFα. sPD-1 was not associated with psychological measures. This preliminary study found for the first time that some psychological measures could be linked to responses to cancer treatment, possibly via pro-inflammatory cytokines and sCTLA-4.
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Affiliation(s)
- Miri Cohen
- School of Social Work, University of Haifa, Haifa 3498838, Israel;
| | - Yosi Shamay
- Biomedical Engineering, Technion—Israel Institute of Technology, Haifa 3109601, Israel;
| | - Johanna Czamanski-Cohen
- Emili Sagol Creative Arts Therapies Research Center, School of Creative Arts Therapies, University of Haifa, Haifa 3498838, Israel; (J.C.-C.); (M.D.)
| | - Katerina Shulman
- Carmel Medical Center, Haifa 3436212, Israel; (K.S.); (L.M.L.)
- Bruce Rappaport Faculty of Medicine, Technion—Israel Institute of Technology, Haifa 3109601, Israel
- Lin Medical Center, Haifa 6688304, Israel;
| | | | - Mahmoud Abu-Amna
- Cancer Center, Emek Medical Center, Afula 1834111, Israel; (M.A.-A.); (I.T.)
| | - Ilit Turgeman
- Cancer Center, Emek Medical Center, Afula 1834111, Israel; (M.A.-A.); (I.T.)
| | - Ludmila Merkin Livshits
- Carmel Medical Center, Haifa 3436212, Israel; (K.S.); (L.M.L.)
- Lin Medical Center, Haifa 6688304, Israel;
| | | | - Monica Dines
- Emili Sagol Creative Arts Therapies Research Center, School of Creative Arts Therapies, University of Haifa, Haifa 3498838, Israel; (J.C.-C.); (M.D.)
| | - Gil Bar-Sela
- Bruce Rappaport Faculty of Medicine, Technion—Israel Institute of Technology, Haifa 3109601, Israel
- Cancer Center, Emek Medical Center, Afula 1834111, Israel; (M.A.-A.); (I.T.)
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Parsons HM, Banegas MP, Bar-Sela G, Jones SM. Editorial: Financial anxiety in cancer prevention and control. Front Psychol 2023; 14:1304079. [PMID: 37908816 PMCID: PMC10615129 DOI: 10.3389/fpsyg.2023.1304079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 10/02/2023] [Indexed: 11/02/2023] Open
Affiliation(s)
- Helen M. Parsons
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Matthew P. Banegas
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, San Diego, CA, United States
| | - Gil Bar-Sela
- Cancer Center, Emek Medical Center, Afula, Israel
| | - Salene M. Jones
- Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, WA, United States
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Shachar SS, Leviov M, Yerushalmi R, Drumea K, Tokar M, Soussan-Gutman L, Bareket-Samish A, Sonnenblick A, Ben-Baruch N, Evron E, Gal-Yam EN, Paluch-Shimon S, Bar-Sela G, Goldvaser H, Stemmer SM. Second breast cancer: recurrence score results, clinicopathologic characteristics, adjuvant treatments, and outcomes-exploratory analysis of the Clalit registry. NPJ Breast Cancer 2023; 9:79. [PMID: 37775723 PMCID: PMC10541873 DOI: 10.1038/s41523-023-00586-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 09/19/2023] [Indexed: 10/01/2023] Open
Abstract
Data on using the 21-gene Recurrence Score (RS) testing on second breast cancer (BC; second primary or local recurrence) are lacking. This cohort study examined patients with first and second BC, who underwent 21-gene testing both times. It included a 'study-cohort' (60 N0/N1mi/N1 ER + HER2‒ BC patients with ≥2 RS results >1 year apart) and a 'general 21-gene-tested BC-cohort' (2044 previously described N0/N1mi/N1 patients). The median time between the first and second BC was 5.2 (IQR, 3.1-7.1) years; the second BC was ipsilateral in 68%. Patient/tumor characteristics of the first- and second-BC in the 'study-cohort' were similar, except for the RS which was higher in the second BC (median [IQR]: 23 [17-30] vs 17 [14-22], p < 0.001). Overall, 56 patients had follow-up data, of whom 5 experienced distant recurrence (2 RS 11-25 patients and 3 RS 26-100 patients). Studies exploring the prognostic utility of the RS in this setting are warranted.
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Affiliation(s)
- Shlomit S Shachar
- Sourasky Medical Center, Tel Aviv, Israel.
- Tel Aviv University, Tel Aviv, Israel.
| | | | - Rinat Yerushalmi
- Tel Aviv University, Tel Aviv, Israel
- Rabin Medical Center, Petah Tikva, Israel
| | | | - Margarita Tokar
- Soroka University Medical Center and Ben Gurion University, Beer Sheva, Israel
| | | | | | - Amir Sonnenblick
- Sourasky Medical Center, Tel Aviv, Israel
- Tel Aviv University, Tel Aviv, Israel
| | | | - Ella Evron
- Kaplan Medical Center, Rehovot, Israel
- Hebrew University Medical School, Jerusalem, Israel
| | - Einav Nili Gal-Yam
- Tel Aviv University, Tel Aviv, Israel
- Sheba Medical Center, Ramat Gan, Israel
| | - Shani Paluch-Shimon
- Hebrew University Medical School, Jerusalem, Israel
- Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Gil Bar-Sela
- Emek Medical Center, Afula, Israel
- Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Hadar Goldvaser
- Hebrew University Medical School, Jerusalem, Israel
- Shaare Zedek Medical Center, Jerusalem, Israel
| | - Salomon M Stemmer
- Tel Aviv University, Tel Aviv, Israel
- Rabin Medical Center, Petah Tikva, Israel
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9
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Schultz M, Baziliansky S, Mitnik I, Ulitzur N, Illouz S, Katra D, Givoli S, Campisi-Pinto S, Bar-Sela G, Zalman D. Associations Between Psycho-Social-Spiritual Interventions, Fewer Aggressive End-of-Life Measures, and Increased Time After Final Oncologic Treatment. Oncologist 2023; 28:e287-e294. [PMID: 37036873 PMCID: PMC10166162 DOI: 10.1093/oncolo/oyad037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 01/31/2023] [Indexed: 04/11/2023] Open
Abstract
BACKGROUND Little is known about the impact of spiritual caregivers, psychologists, and social workers on desired end-of-life (EoL) medical outcomes, such as reduced use of aggressive care in the final 2 weeks of life, having more time between the last active oncological treatment and death, and increased hospice use. PATIENTS AND METHODS We conducted a prospective study of 180 patients with cancer and their families, their interactions with social work, psychology, and spiritual care, and the above three treatment outcomes. RESULTS We found that having one or more spiritual care visits (adjusted odds ratio (AOR) = 2.02; P = .04), having more quality visits with the psychologist (P = .01), and speaking with someone about one's inner resources (AOR = 2.25; P = .03) all correlated with reduced EoL aggressive care. The key interventions correlating with increased time after final treatment were more visits with the spiritual caregiver or the social worker (AOR = 1.30; P < .001), and speaking about the medical treatment (AOR = 1.54; P < .001) and about interpersonal relationships (AOR = 2.28; P < .001). A subjectively good-quality connection with the spiritual caregiver correlated with increased hospice use (AOR = 10.00; P = .01). CONCLUSIONS Patients with cancer who availed themselves of the spiritual care, psychology, and social work services, each profession in distinct ways, had significantly different outcomes in their EoL medical treatment, including undergoing fewer futile aggressive measures, having more time after their last active treatment, and using hospice services more. These outcomes directly bear on improved quality of life and reduced costs.
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Affiliation(s)
- Michael Schultz
- Division of Oncology, Rambam Health Care Campus, Haifa, Israel
| | | | - Inbal Mitnik
- Division of Oncology, Rambam Health Care Campus, Haifa, Israel
| | - Nirit Ulitzur
- Division of Oncology, Rambam Health Care Campus, Haifa, Israel
| | - Shay Illouz
- Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Duaa Katra
- Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | | | | | - Gil Bar-Sela
- Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Cancer Center, Emek Medical Center, Afula, Israel
| | - Daniela Zalman
- Division of Oncology, Rambam Health Care Campus, Haifa, Israel
- Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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10
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Averbuch I, Stoff R, Miodovnik M, Fennig S, Bar-Sela G, Yakobson A, Daliot J, Asher N, Fenig E. Avelumab for the treatment of locally advanced or metastatic Merkel cell carcinoma-A multicenter real-world experience in Israel. Cancer Med 2023. [PMID: 37012213 DOI: 10.1002/cam4.5890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/24/2023] [Accepted: 03/12/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Merkel cell carcinoma (MCC) is a rare and aggressive malignancy of the skin, affecting predominantly the fair-skinned older population exposed to high levels of ultraviolet light. Immune suppression is considered a significant risk factor. With the recent advances in the field of immunotherapy, the treatment paradigm for advanced MCC, traditionally based on chemotherapy, has largely shifted to anti-PD-L1 and PD-1 agents such as avelumab and pembrolizumab, respectively. However, real-world data remain sparse. The aim of this study was to assess real-world evidence of the effectiveness of avelumab in a diverse group of patients with MCC in Israel. METHODS The electronic databases of five university hospitals in Israel were searched for all consecutive patients with MCC treated with at least one dose of avelumab in 2018-2022. Data on baseline, disease-related, treatment-related, and outcome parameters were collected and analyzed. RESULTS The cohort included 62 patients of whom 22% were immune-suppressed. The overall response rate to avelumab was 59%. The median progression-free survival was 8.1 months, and the median overall survival, 23.5 months, with no differences between immune-competent and immune-suppressed patients. Treatment was well tolerated; any-grade toxicity developed in 34% of patients, and grade 3-4 toxicity, in 14%. CONCLUSIONS Avelumab was found to be effective and safe for the treatment of advanced MCC in a diverse group of patients, including some with immune suppression. Further studies are warranted to evaluate the optimal sequence and duration of treatment and to assess the potential role of avelumab for earlier stages of MCC.
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Affiliation(s)
- Itamar Averbuch
- Davidoff Cancer Center, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ronen Stoff
- Ella Institute for Immuno-Oncology, Sheba Medical Center, Sackler, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mor Miodovnik
- Department of Dermatology, Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomit Fennig
- Institute of Oncology, Kaplan Medical Center, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Gil Bar-Sela
- Cancer Center, Emek Medical Center, Rappaport Faculty of Medicine, Israel Institute of Technology-Technion, Haifa, Israel
| | - Alexander Yakobson
- The Legacy Heritage Oncology Center & Dr. Larry Norton Institute, Soroka Medical Center, School of Medicine, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Jonathan Daliot
- Davidoff Cancer Center, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Natan Asher
- Ella Institute for Immuno-Oncology, Sheba Medical Center, Sackler, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Fenig
- Davidoff Cancer Center, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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11
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Avisar A, Cohen M, Aharon A, Katz R, Bar-Sela G. Positive affect and fatigue as predictors of anti-inflammatory IL-10 concentrations among colorectal cancer patients during adjuvant chemotherapy. J Psychosom Res 2023; 167:111162. [PMID: 36796157 DOI: 10.1016/j.jpsychores.2023.111162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 01/16/2023] [Accepted: 01/18/2023] [Indexed: 01/30/2023]
Abstract
OBJECTIVES (1) To examine the relationships of positive and negative affect and symptoms of depression, anxiety, and fatigue at baseline with the anti-inflammatory cytokine IL-10 concentrations in serum at three points in colorectal cancer patients; and (2) to assess the relationship between these factors and disease recurrence or mortality after a median follow-up of 24 months. METHODS In a prospective trial, 92 stage II or III colorectal cancer patients scheduled to receive standard chemotherapy were enrolled. Blood samples were collected prior to start of chemotherapy onset (T0), 3 months later (T1), and upon chemotherapy completion (T2). RESULTS IL-10 concentrations were similar across the time points. Linear mixed-effects model analysis showed that controlling for confounders, higher positive affect and lower fatigue pretreatment (T0) predicted IL-10 concentrations across the time points (estimate = 0.18, SE = 0.08, 95% CI = 0.03, 0.34, p < .04 and estimate = -0.25, SE = 0.12, 95% CI = -0.50, 0.01, p < .04, respectively). Depression at T0 significantly predicted higher disease recurrence and mortality (estimate = 0.17, SE = 0.08, adjusted OR = 1.18, 95% CI = 1.02, 1.38, p = .03). CONCLUSIONS We report on associations not previously assessed between positive affect and fatigue and the anti-inflammatory cytokine IL-10. Results add to previous findings suggesting that positive affect and fatigue could have a role in anti-inflammatory cytokine dysregulation.
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Affiliation(s)
- Adva Avisar
- The Graduate Studies Authority, University of Haifa, Haifa, Israel
| | - Miri Cohen
- School of Social Work, University of Haifa, Haifa, Israel
| | - Anat Aharon
- Hematology Research Laboratory, Department of Hematology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rina Katz
- Clinical Immunology and Tissue Typing Lab, Rambam Health Care Campus, Haifa, Israel
| | - Gil Bar-Sela
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; Cancer Center, Emek Medical Center, Afula, Israel.
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12
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Bar-Sela G, Tur-Sinai A, Givon-Schaham N, Bentur N. Advance Care Planning and Attainment of Cancer Patients' End-of-Life Preferences: Relatives' Perspective. Am J Hosp Palliat Care 2023; 40:322-328. [PMID: 35587799 PMCID: PMC9941650 DOI: 10.1177/10499091221099921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE The purpose of this study is to determine which element of advance care planning (ACP) - an advance directives (AD) document or an end-of-life discussion between patient and family (DwF), if any-improves the likelihood of cancer patients' attaining their preferences regarding treatments in the last month of life and dying in the place they prefer. METHODS First-degree relatives of deceased cancer patients, interviewed by telephone, were asked if the treatments the patients received in their last month of life and their place of death corresponded to the patients' preferences. Nominal logistic regression analyses were conducted in search of significant association between having an AD document and/or conducting a DwF and patients' treatment and place of death in accordance with their preferences. RESULTS 491 deceased patients were included in the study. Their average age was 68; 52% were women. According to 32% of the relatives, the patients' treatment in the last month of life was aligned with their preferences and 55% said the patients had died in their preferred place. Only 16.5% had an AD document, 58.5% only discussed their treatment preferences with relatives, and 25% did neither. DwF and ability to speak until last week of life were significantly related to receiving treatment consistent with patients' preferences. Dying where the patient prefers is significantly associated with having an AD and a DwF, with an AD yielding higher odds. CONCLUSION A multifaceted interconnection exists between the two elements of ACP in attaining cancer patients' wishes and abetting better end of life care.
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Affiliation(s)
- Gil Bar-Sela
- Oncology and Hematology Division, Emek Medical Center, Israel
| | - Aviad Tur-Sinai
- Department of Health Systems Management, The Max Stern Yezreel Valley College, Jezreel Valley, Israel,School of Nursing, University of Rochester Medical Center, New York
| | - Noa Givon-Schaham
- The Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Netta Bentur
- The Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel-Aviv University, Israel,Netta Bentur, The Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
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13
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Cohen I, Campisi-Pfinto S, Rozenberg O, Colodner R, Bar-Sela G. The Humoral Response of Patients With Cancer to Breakthrough COVID-19 Infection or the Fourth BNT162b2 Vaccine Dose. Oncologist 2023; 28:e225-e227. [PMID: 36856804 PMCID: PMC10078898 DOI: 10.1093/oncolo/oyad003] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 12/22/2022] [Indexed: 03/02/2023] Open
Abstract
Since January 2022 in Israel, high-risk populations with underlying health conditions were advised to receive a fourth dose of the BNT162b2 vaccine (Pfizer-BioNTech) against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We monitored vaccine-induced immunity among oncology patients undergoing systemic anti-cancer therapy before and after the 4th-BNT162b2-dose. Three groups of patients were included in the study: those who received 3rd-BNT162b2-dose and had no breakthrough infection (control), those who received 3rd-BNT162b2-dose and had the breakthrough infection, and those who received the 4th-BNT162b2-dose and had no breakthrough infection. Anti-SARS-CoV-2 immunoglobulin-G (IgG) levels of the control group exhibited a rapid decrease over time, whereas IgG titers of patients with breakthrough-infections or patients vaccinated with the 4th-BNT162b2-dose were considerably elevated, consistent with the capacity of the second booster to induce anti-SARS-CoV-2 IgG levels. Additionally, oncology patients' humoral immune response was significantly greater after breakthrough-infection than in response to the 4th dose of BNT162b2.
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Affiliation(s)
- Idan Cohen
- Cancer Center, Emek Medical Center, Afula, Israel
| | | | - Orit Rozenberg
- Emek Medical Center, Clalit Clinical Laboratories, Afula, Israel
| | - Raul Colodner
- Emek Medical Center, Clalit Clinical Laboratories, Afula, Israel
| | - Gil Bar-Sela
- Cancer Center, Emek Medical Center, Afula, Israel.,Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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14
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Badran O, Abu Amna M, Turgeman I, Bar-Sela G. Rhabdomyolysis Induced by the Interaction Between Ribociclib and Statins- Case Report and Literature Review. Breast Cancer (Dove Med Press) 2023; 15:47-50. [PMID: 36718280 PMCID: PMC9883986 DOI: 10.2147/bctt.s380485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 01/07/2023] [Indexed: 01/24/2023]
Abstract
Cyclin-dependent kinase (CDK) 4/6 inhibitors given with endocrine therapy are standard of care for the treatment of women with advanced hormone receptor (HR) positive and human epidermal growth factor receptor 2 (HER-2) negative breast cancer. Ribociclib is a CDK 4/6 inhibitor with moderate to solid inhibition of CYP3A4, a member of the cytochrome P450 family oxidase system, which may lead to interactions with medicinal substrates that are metabolized via CYP3A4. Statins are among the most widely prescribed medications worldwide, predominantly metabolized by the CYP3A4 isoenzyme. Rhabdomyolysis is a known rare side effect of statins, commonly triggered by drug interactions. We report a case of a 73-year-old woman with metastatic HR-positive and HER-2 negative breast cancer who developed rhabdomyolysis and acute kidney injury due to interaction between simvastatin and ribociclib with a literature review.
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Affiliation(s)
- Omar Badran
- Department of Oncology, Emek Medical Center, Afula, Israel
| | - Mahmoud Abu Amna
- Department of Oncology, Emek Medical Center, Afula, Israel,Technion Integrated Cancer Center, Faculty of Medicine, Technion, Haifa, Israel
| | - Ilit Turgeman
- Department of Oncology, Emek Medical Center, Afula, Israel
| | - Gil Bar-Sela
- Department of Oncology, Emek Medical Center, Afula, Israel,Technion Integrated Cancer Center, Faculty of Medicine, Technion, Haifa, Israel,Correspondence: Gil Bar-Sela, Oncology & Hematology Division, Emek Medical Center, Yitshak Rabin Boulevard 21, Afula, 1834111, Israel, Tel +972 04-6495725, Fax +972 04-6163992, Email
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15
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Muscaritoli M, Bar-Sela G, Battisti NML, Belev B, Contreras-Martínez J, Cortesi E, de Brito-Ashurst I, Prado CM, Ravasco P, Yalcin S. Oncology-Led Early Identification of Nutritional Risk: A Pragmatic, Evidence-Based Protocol (PRONTO). Cancers (Basel) 2023; 15:cancers15020380. [PMID: 36672329 PMCID: PMC9856655 DOI: 10.3390/cancers15020380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 12/22/2022] [Accepted: 12/30/2022] [Indexed: 01/11/2023] Open
Abstract
Nutritional issues, including malnutrition, low muscle mass, sarcopenia (i.e., low muscle mass and strength), and cachexia (i.e., weight loss characterized by a continuous decline in skeletal muscle mass, with or without fat loss), are commonly experienced by patients with cancer at all stages of disease. Cancer cachexia may be associated with poor nutritional status and can compromise a patient's ability to tolerate antineoplastic therapy, increase the likelihood of post-surgical complications, and impact long-term outcomes including survival, quality of life, and function. One of the primary nutritional problems these patients experience is malnutrition, of which muscle depletion represents a clinically relevant feature. There have been recent calls for nutritional screening, assessment, treatment, and monitoring as a consistent component of care for all patients diagnosed with cancer. To achieve this, there is a need for a standardized approach to enable oncologists to identify patients commencing and undergoing antineoplastic therapy who are or who may be at risk of malnutrition and/or muscle depletion. This approach should not replace existing tools used in the dietitian's role, but rather give the oncologist a simple nutritional protocol for optimization of the patient care pathway where this is needed. Given the considerable time constraints in day-to-day oncology practice, any such approach must be simple and quick to implement so that oncologists can flag individual patients for further evaluation and follow-up with appropriate members of the multidisciplinary care team. To enable the rapid and routine identification of patients with or at risk of malnutrition and/or muscle depletion, an expert panel of nutrition specialists and practicing oncologists developed the PROtocol for NuTritional risk in Oncology (PRONTO). The protocol enables the rapid identification of patients with or at risk of malnutrition and/or muscle depletion and provides guidance on next steps. The protocol is adaptable to multiple settings and countries, which makes implementation feasible by oncologists and may optimize patient outcomes. We advise the use of this protocol in countries/clinical scenarios where a specialized approach to nutrition assessment and care is not available.
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Affiliation(s)
- Maurizio Muscaritoli
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy
- Correspondence:
| | - Gil Bar-Sela
- Oncology Department, Emek Medical Center, Afula 1834111, Israel
| | - Nicolo Matteo Luca Battisti
- The Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK
- Breast Cancer Research Division, The Institute of Cancer Research, London SW3 6JJ, UK
| | - Borislav Belev
- Clinical Hospital Center Zagreb, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | | | - Enrico Cortesi
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, 00185 Rome, Italy
| | | | - Carla M. Prado
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Paula Ravasco
- Faculty of Medicine and Centre for Interdisciplinary Research in Health (CIIS-UCP), Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal
- Centre for Interdisciplinary Research Egas Moniz (CiiEM), Instituto Universitário Egas Moniz, 2829-511 Almada, Portugal
| | - Suayib Yalcin
- Department of Medical Oncology, Institute of Cancer, Hacettepe University, Ankara 06800, Turkey
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16
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HaGani N, Sznitman S, Dor M, Bar-Sela G, Oren D, Margolis-Dorfman L, Goor-Aryeh I, Green MS. Attitudes Toward the Use of Medical Cannabis and the Perceived Efficacy, Side-effects and Risks: A Survey of Patients, Nurses and Physicians. J Psychoactive Drugs 2022; 54:393-402. [PMID: 34893011 DOI: 10.1080/02791072.2021.2009598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Gaps between physician and patient perceptions may lead to misunderstandings and mismanage of treatment. There are sparse data about the differences in opinions toward medical cannabis (MC) between patients and health professionals. The aim of this study was to examine the attitudes toward MC, its perceived efficacy, side effects and risk of dependency, among patients, nurses and physicians. A cross-sectional study of samples of 430 patients, 65 nurses and 65 physicians in two large medical centers in Israel. Questionnaires were administered on attitudes, perceived efficacy, side-effects and perceived risks of dependency. Compared with nurses and physicians, patients who were using MC had the most positive attitudes toward MC (p < .001). Younger age, high school education, being Jewish and ever using MC, were associated with more positive attitudes toward MC among patients (p < .001). Among nurses and physicians, having an oncology specialty predicted more positive attitudes toward MC. Physicians had a less positive attitude toward MC compared to nurses (p < .01). Our study provides evidence that physicians are less positive in their views toward MC compared to nurses and patients. More information and awareness to MC may reduce the gap in perceptions between physicians and patients.
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Affiliation(s)
- Neta HaGani
- School of Public Heath, University of Haifa, Haifa, Israel.,Rambam Medical Center, Haifa, Israel
| | | | - Michael Dor
- Department of Health Systems Management, Ariel University, Ari'el, Israel
| | - Gil Bar-Sela
- Oncology and Hematology Division, Emek Medical Center, Afula, Israel.,Faculty of Medicine, Technion, Haifa, Israel
| | - Dana Oren
- Pain Medicine Institute, Sheba Medical Center, Ramat Gan, Israel
| | | | - Itay Goor-Aryeh
- Pain Medicine Institute, Sheba Medical Center, Ramat Gan, Israel
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17
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Shachar SS, Bar-Sela G, Peer A, Moskovitz MT, Bareket-Samish A, Epstein J, Wollner M, Shafran I, Boukal A, Williams GR. The association between geriatric assessment, muscle measures, and treatment-related toxicity in older adults with cancer: An Israeli prospective study. J Geriatr Oncol 2022; 13:1203-1207. [PMID: 35989184 DOI: 10.1016/j.jgo.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 07/11/2022] [Accepted: 08/11/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We investigated the associations among frailty, as determined via the comprehensive geriatric assessment (CGA), muscle measures (i.e., sarcopenia), and treatment-related toxicity in older adults with cancer in Israel. MATERIALS AND METHODS This prospective cohort study enrolled patients ≥65 years with newly-diagnosed stage IV lung, breast, or genitourinary cancer. Patients were enrolled and completed CGA before their first line of systemic therapy (chemotherapy, biologic therapy, immunologic therapy, or a combination thereof). CGA was used to classify patients as robust, pre-frail, or frail, and routine pre-treatment computed tomography (CT) images were used to quantify skeletal muscle index (SMI) and skeletal muscle density (SMD) at L3 cross-section. Two sarcopenia definitions were used: i. for women SMI <41 cm2/m2 regardless of body mass index (BMI), and for men SMI <43 cm2/m2 for those with BMI of <25 and < 53 cm2/m2 for those with BMI ≥25; and ii. SMI <38 cm2/m2 for women and < 41 cm2/m2 for men, regardless of BMI. The associations between frailty and muscle measures with the occurrence of at least one adverse event (AE) grade ≥ 2 were examined using the chi-square test, and logistic regression to determine odds ratio (OR) and 95% confidence interval (CI). RESULTS In total, 51 patients were included in the analysis. The median (interquartile range) age was 72 (68-76) years, 30 (59%) were male, and 26 (51%) had lung cancer. CGA data were available for 48 patients: fifteen (31%), thirteen (27%), and twenty (42%) were defined as robust, pre-frail, and frail, respectively. Overall, 33 (65%) were sarcopenic by the first aforementioned definition, and sixteen (31%) by the second. No statistically significant associations were identified between frailty and having at least one AE grade ≥ 2, or between frailty and sarcopenia. Statistically significant associations were found between having sarcopenia (the second definition) and having at least one AE grade ≥ 2 (P = 0.0217). The corresponding odds ratio (95% CI) was 4.2 (1.2-15.0), P = 0.026. DISCUSSION Our findings suggests that sarcopenia is significantly associated with treatment-related toxicity. Further studies with larger sample sizes are warranted.
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Affiliation(s)
- Shlomit S Shachar
- Division of Oncology, Sourasky- Tel Aviv Medical Center, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Gil Bar-Sela
- Emek Medical Center, Department of Oncology, Afula, Israel; Technion Rappaport Faculty of Medicine, Haifa, Israel
| | - Avivit Peer
- Technion Rappaport Faculty of Medicine, Haifa, Israel; Ramban Health Care Campus, Haifa, Israel
| | - Mor Tal Moskovitz
- Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel
| | | | - Jessica Epstein
- Division of Oncology, Sourasky- Tel Aviv Medical Center, Tel Aviv, Israel
| | | | - Itamar Shafran
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amit Boukal
- Technion Rappaport Faculty of Medicine, Haifa, Israel
| | - Grant R Williams
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
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18
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Turgeman I, Campisi-Pinto S, Habiballah M, Bar-Sela G. Approach to Cancer Pain Management in Emergency Departments: Comparison of General and Oncology Based Settings. Pharmaceuticals (Basel) 2022; 15:ph15070805. [PMID: 35890103 PMCID: PMC9320698 DOI: 10.3390/ph15070805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 06/13/2022] [Accepted: 06/21/2022] [Indexed: 11/22/2022] Open
Abstract
Cancer-related pain constitutes a dominant reason for admission to emergency services, and a significant patient and healthcare challenge. Evidence points to the rising prevalence of opioid misuse in this patient group. We sought to compare drug delivery in an oncology-dedicated emergency department (OED) and a general emergency department (GED) within the same hospital. As such, we obtained patient and drug-related data for OED and GED during a designated three-month period, and compared them using Fisher’s exact test, chi-square tests and the Mann-Whitney test. In total, 584 patients had 922 visits to emergency services (OED n = 479; GED n = 443), and were given 1478 drugs (OED n = 557; GED n = 921). Pain was a prominent chief complaint among visitors to the OED (17%) and GED (21%). Approximately a fifth of all drugs used were analgesics (OED—18.5%; GED—20.4%), however, in the GED, 51.6% (n = 97) were used for non-pain-related admissions, compared with 33.0% (n = 34) in OED. Opioid usage significantly differed between emergency settings. The GED administered three times as many intravenous opioids (p <0.001), a narrower spectrum of oral and intravenous drugs (p = 0.003) and no rapid-acting opioids, significantly fewer pain adjuvants (10.9% versus 18.7%, p < 0.001), and, finally, non-guideline-recommended drugs for pain, such as meperidine and benzodiazepines. Taken together, compared with the GED, the management of cancer-related pain in the OED was more personalized, and characterized by fewer intravenous opioids, enhanced diversity in drug type, route and method of delivery. Efforts should be directed toward reduction of disparities in the treatment of cancer pain in emergency settings.
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Affiliation(s)
- Ilit Turgeman
- Cancer Center, Emek Medical Center, Afula 1834111, Israel;
| | | | - Maher Habiballah
- Division of Oncology, Rambam Health Care Center, Haifa 31096, Israel;
| | - Gil Bar-Sela
- Cancer Center, Emek Medical Center, Afula 1834111, Israel;
- Technion Integrated Cancer Center, Faculty of Medicine, Technion—Israel Institute of Technology, Haifa 31096, Israel
- Correspondence: ; Tel.: +4-6495725; Fax: +4-6163992
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19
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Sun XS, Le Guevelou J, Jacquemin J, Drouet Y, Sio TS, Bar-Sela G, Carrie C, Faivre JC, Khalifa J, Demiroz C, Qiu H, Schick U, Atalar B, Fakhry N, Mengue L, Pan J, Servagi-Vernat S, Thariat J. Impact of radiotherapy on survival in resected or unresectable anaplastic thyroid carcinomas, a Rare Cancer Network study. Cancer Radiother 2022; 26:717-723. [PMID: 35715353 DOI: 10.1016/j.canrad.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 01/04/2022] [Accepted: 01/14/2022] [Indexed: 11/15/2022]
Abstract
PURPOSE Anaplastic thyroid carcinomas (ATC) are a heterogenous group of tumors of overall dismal prognosis. We designed models to identify relevant prognostic factors of survival of irradiated ATC patients including radiotherapy modalities (field size, dose). MATERIAL AND METHODS Between 2000 and 2017, 166 ATC patients' treatments were divided into surgery and postoperative radiotherapy (poRT) or definitive radiotherapy (RT). Multiple imputation approach was used for missing data. Prognostic factors were identified using Lasso-penalized Cox modelling and predicted risk scores were built. RESULTS Patients undergoing RT (n=70) had more adverse patient and disease characteristics than those undergoing poRT (n=96). Corresponding median survival rates were 5.4 and 12.1 months, respectively. PoRT patients undergoing poRT more likely received extended-field radiotherapy with prophylactic nodal irradiation, but rather received platinum- vs. adriamycin-based chemoradiotherapy. Radiotherapy was conventionally fractionated, delivered >60Gy in 51.9% and 61.7% and used extended fields in 88.5% and 71.2% of patients with poRT or RT. Radiotherapy interruption rates for toxicity were similar in the two groups. The best poRT-group model identified age>45yo, PS≥1, pathologic tumor stage≥pT4b,>N1 and R2 resection as poor prognostic factors. The best RT-group model (C-index of 0.72) identified PS≥3,>N1 and extended-field radiotherapy with prophylactic nodal irradiation (as opposed to tumour-bed irradiation only) as poor prognostic factors. CONCLUSION In patients undergoing poRT, radiotherapy parameters had little influence over their survival irrespective of patient, disease characteristics, and quality of resection. In patients undergoing RT, extended-field radiotherapy improved survival in addition to PS and nodal stage.
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Affiliation(s)
- X S Sun
- Department of Radiation Therapy, University Hospital Besancon-Montbeliard, Montbeliard, France.
| | - J Le Guevelou
- Department of Radiation Oncology, Centre François Baclesse, Caen, France
| | - J Jacquemin
- Département Prévention et Santé Publique, Centre Léon Bérard, Lyon, France
| | - Y Drouet
- Département Prévention et Santé Publique, Centre Léon Bérard, Lyon, France
| | - T S Sio
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona, USA
| | - G Bar-Sela
- Department of Radiation Oncology, Rambam health Care Campus, Haifa, Israel
| | - C Carrie
- Department of Radiation Oncology, Centre Leon Berard, Lyon, France
| | - J-C Faivre
- Department of Radiation Oncology, Institut de Cancérologie de Lorraine, Nancy, France
| | - J Khalifa
- Department of Radiation Oncology, Oncopole, Toulouse, France
| | - C Demiroz
- Department of Radiation Oncology, Uludag University school of medicine, Bursa, Turkey
| | - H Qiu
- Department of Radiation Oncology, University Hospital, Limoges, France
| | - U Schick
- Department of Radiation Oncology, CHRU Brest, Brest, France
| | - B Atalar
- Department of Radiation Oncology, University Hospital Acibadem MAA University, School of Medicine, Istanbul, Turkey
| | - N Fakhry
- Department of Surgery, CHU La Conception, Marseille, France
| | - L Mengue
- Department of Radiation Therapy, University Hospital Besancon-Montbeliard, Montbeliard, France
| | - J Pan
- Department of Radiation Oncology, Fujian Province Tumor Hospital, Fuzhou, China
| | - S Servagi-Vernat
- Department of Radiation Oncology, Institut Jean Godinot, Reims, France
| | - J Thariat
- Department of Radiation Oncology, Centre François Baclesse, Caen, France
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Shachar SS, Leviov M, Yerushalmi R, Drumea K, Tokar M, Soussan-Gutman L, Bareket-Samish A, Sonnenblick A, Ben Baruch N, Evron E, Gal-Yam EN, Paluch-Shimon S, Bar-Sela G, Goldvaser H, Stemmer SM. Recurrence Score (RS) results, clinicopathologic characteristics, treatments, and outcomes in primary versus subsequent breast cancer (BC): Exploratory analysis of the Clalit Health Services (CHS) registry. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
565 Background: In this exploratory analysis of the CHS registry we investigated differences in RS results and clinicopathologic characteristics between a primary and subsequent BC as well as the association with treatments received (after the first BC) and clinical outcomes. Methods: The analysis included all ER+ HER2-negative BC pts who were RS-tested through CHS between 1/2006 and 12/2020, had ≤3 positive lymph nodes in their first BC, and ≥2 RS results > 1 yr apart. Results: The analysis included 60 pts (all had second BC, 2 also had a third BC). All were female; the median age at diagnosis of the first BC was 56 (IQR, 44-62) yrs and at the subsequent diagnosis, 61 (50-67) yrs. In the first diagnosis, 46/14 pts (77%/23%) were N0/node-positive; in the subsequent BC, it was 50/9 pts (81%/15%), (missing data for 3 pts [5%]). Of the 46 N0 pts at the first BC, 37 (80%) were N0 in the subsequent BC. Tumor characteristics were similar between the first and the subsequent BC tumors. No statistically significant differences were observed between the first and subsequent tumors with respect to tumor size, grade, histology, and the proportion of N0 vs N1/N1mi pts. The RS results were statistically significantly higher in the subsequent BC vs the first (mean [SD] of 24 [12)] vs 19 [10]; P =.00062, Mann-Whitney test). In the first BC, 7 (12%), 44 (73%), and 9 (15%) had RS 0-10, 11-25, and 26-100, respectively. In the subsequent BC, the distribution shifted with more pts in the higher RS category (5 [8%], 32 [52%], and 25 [40%], respectively; P =.0072, χ2-test). The differences in the RS between the first and subsequent BC varied considerably between pts (median difference, 6; IQR, -0.25 to 11.0; range, -50 to 56). Of the 46 pts with N0 at the first BC, 36 (78%) received endocrine therapy (ET), 34 (74%) received radiation therapy (RT), and 5 (11%) received CT after the first BC diagnosis; of the 14 N1mi/N1 pts, 12 (86%) received ET, 12 (86%) RT, and 4 (29%) CT after the first BC diagnosis. In 45 N0 pts with available information, higher RS in the subsequent BC was observed more often in irradiated breasts (pts who received RT to the breast that was subsequently diagnosed with second/third BC, n = 23) vs non-irradiated breast (pts with no RT or pts with subsequent BC in the opposite breast, n = 22): 83% vs 55%, P =.042; χ2-test. No other statistically significant associations were observed between treatments received after the first diagnosis and RS differences between the first and subsequent BC diagnoses. With a median (IQR) follow up of 4.2 (1.6-8.2) yrs from the latest diagnosis, 5 distant recurrences were reported: 2 in pts with RS≤25 in their second BC (of whom one had N1 BC), and 3 in pts with RS > 25 in their second BC. Conclusions: In ER+ HER2-negative BC pts, the RS in a second/third BC is generally higher than the first, particularly if the breast involved was irradiated.
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Affiliation(s)
| | - Michelle Leviov
- Lin Medical Center, Faculty of Medicine, Technion, Haifa, Israel
| | - Rinat Yerushalmi
- Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel
| | | | - Margarita Tokar
- Department of Oncology, Soroka University Medical Center, Beer Sheva, Israel
| | | | | | - Amir Sonnenblick
- Oncology Division, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | | | | | | | | | - Hadar Goldvaser
- Oncology Institute, Shaare Zedek Medical Center, Jerusalem, Israel
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21
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Zidan J, Leviov M, Kuchuk I, Bar-Sela G, Shai A, Kazarin O, Suheil N. The use of clinical impact of the breast cancer intrinsic subtype-Prosigna assay for adjuvant treatment decision in early breast cancer with hormone receptor positive and HER-2 negative Middle East women. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e12527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e12527 Background: Clinico-pathological evaluations of intrinsic subtypes by immunohistochemistry (IHC) are routinely used for treatment decision in patients with early-stage breast cancer (EBC). The Prosigna (PAM50) gene signature, is validated test measures the expression levels of 50 genes from formalin-fixed paraffin-embedded (FFPE) tumor samples. It permits intrinsic subtype classification of tumor and prognostic test of risk of recurrence (ROR) score. The objectives of this study were to evaluate the impact of Prosigna results on type of adjuvant treatment in EBC, to overcome disparities by comparing the results on different ethnicity groups in Israel and to asses physicians treatment decision before and after Prosigna results. Methods: This prospective, observational study was carried out in 7 Medical Centers at Northern Israel. Postmenopausal women with hormone-receptor–positive, human epidermal growth factor receptor 2 (HER2)–negative invasive EBC were enrolled. Physicians completed treatment confidence questionnaires prior to and after receiving Prosigna test results. Only EBC : T 1-2, N0 and N1 were included. Results: Between May 2018 and April 2021, 238 women were enrolled, 204 patients are eligible for this analysis. Ashkenazi Jews were 38%, Sephardi Jews 32% and 30% were Palestinian Arab women. Mean age was 65.28 years. T1 was diagnosed in 82.3%, T2 in 17.3% and N1 in 22.4% of pts. At time of diagnosis tumor subtypes were categorized based on IHC as Luminal A in 50%, 54.4%, 59.5% and Luminal B in 50%, 44.6% and 40.5% of Sephardi, Ashkenazi and Arab patients retrospectively. Intrinsic tumor subtypes detected by the Prosigna test were Luminal A in 63.8%, 71%, 74.3% and Luminal B in 34.5% (+1.7% basal like), 29% and 25.7% respectively. No significant different between these groups. Overall 50.5% of pts were low risk, 26% intermediate risk and 23.5% high risk due to Prosigna results. Following Prosigna results 23.4% of the physicians changed their treatment recommendation. Conclusions: To our knowledge this is the first study using Prosigna test in Middle East women with early breast cancer. The use of Prosigna results led to a 23.4% change in adjuvant treatment decision. The results of this prospective study is similar to the data published in other studies in the literature. The intrinsic tumor subtypes and risk of recurrence detected by Prosigna adds to the physicians' confidence in the choice of treatment type. Prosigna test was additive for understanding the biology and for adjuvant treatment choice in both Jewish and Palestinian women in Israel.
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Affiliation(s)
- Jamal Zidan
- Ziv Medical Center affiliated with Faculty of Medicine (Bar Ilan University), Safed, Israel
| | - Michelle Leviov
- Lin Medical Center, Faculty of Medicine, Technion, Haifa, Israel
| | | | | | - Ayelet Shai
- Oncology Department, Galilee Medical Center, Nahariya, Israel
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22
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Turgeman I, Turgeman S, Lutsyk M, Bar-Sela G. P-295 Prognostic impact of clinico-pathologic parameters in early- and average-onset curatively resected colorectal cancer. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.04.384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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23
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Turgeman I, Campisi-Pinto S, Habiballah M, Bar-Sela G. Pain management in oncology-dedicated and general emergency departments. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e24076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e24076 Background: Cancer-related pain constitutes a dominant reason for admission to emergency services, and a significant patient and healthcare challenge. Evidence points to the rising prevalence of opioid misuse in this patient group. We sought to compare drug delivery in an oncology-dedicated emergency department (OED) and a general emergency department (GED) within the same hospital. Methods: Electronic files of patients with cancer seeking emergency services in a three-month period were obtained from the hospital registry. Data on patient demographics and drug-related characteristics were determined. Drug administration was compared between groups and thereafter according to admission types, using Fisher’s exact test, chi-square test and Mann-Whitney test. Results: In total, 584 patients had 922 visits to emergency services (OED n = 479; GED n = 443), and were administered 1815 drugs (OED n = 825; GED n = 990). Patient demographics and admission types were balanced between groups. Pain was the most common chief complaint (17% OED; 21% GED). In the OED, 12.5% of drugs were direct analgesics, compared with 19% in the GED. Opioids were prescribed more often in the GED than the OED (p = 0.008), significant for both pain related and non-pain related admissions, notably gastrointestinal and infectious conditions. Treatment in the GED was associated with delivery of three times as many intravenous opioids (p < 0.001), a narrower spectrum in selection of oral and intravenous opioids (p = 0.003) and non-opioid analgesics, lower usage of pain adjuvants and rapid-acting opioids (p = 0.003), and finally, the administration of agents not recommended for cancer pain treatment, such as meperidine and benzodiazepines (p = 0.003). Similar utilization of resuscitative fluids, gastrointestinal agents and antiemetics was observed between groups, with larger variation in drug choice in the OED (p = 0.001). The OED showed greater usage of bisphosphonates and growth factors; conversely, antibiotics, blood products, clotting agents, antihypertensive and diabetic drugs, predominated in the GED. Conclusions: Compared to the GED, management of cancer-related pain in the OED is characterized by fewer opioids, enhanced diversity in drug type, route and method of delivery. Emergency services should be incorporated in cancer programs to promote safe and effective urgent care.
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24
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Aviram J, Lewitus GM, Vysotski Y, Amna MA, Ouryvaev A, Procaccia S, Cohen I, Leibovici A, Akria L, Goncharov D, Mativ N, Kauffman A, Shai A, Bar-Sela G, Meiri D. The Effectiveness and Safety of Medical Cannabis for Treating Cancer Related Symptoms in Oncology Patients. Front Pain Res (Lausanne) 2022; 3:861037. [PMID: 35669038 PMCID: PMC9163497 DOI: 10.3389/fpain.2022.861037] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 04/25/2022] [Indexed: 12/12/2022] Open
Abstract
The use of medical cannabis (MC) to treat cancer-related symptoms is rising. However, there is a lack of long-term trials to assess the benefits and safety of MC treatment in this population. In this work, we followed up prospectively and longitudinally on the effectiveness and safety of MC treatment. Oncology patients reported on multiple symptoms before and after MC treatment initiation at one-, three-, and 6-month follow-ups. Oncologists reported on the patients' disease characteristics. Intention-to-treat models were used to assess changes in outcomes from baseline. MC treatment was initiated by 324 patients and 212, 158 and 126 reported at follow-ups. Most outcome measures improved significantly during MC treatment for most patients (p < 0.005). Specifically, at 6 months, total cancer symptoms burden declined from baseline by a median of 18%, from 122 (82-157) at baseline to 89 (45-138) at endpoint (-18.98; 95%CI= -26.95 to -11.00; p < 0.001). Reported adverse effects were common but mostly non-serious and remained stable during MC treatment. The results of this study suggest that MC treatment is generally safe for oncology patients and can potentially reduce the burden of associated symptoms with no serious MC-related adverse effects.
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Affiliation(s)
- Joshua Aviram
- Faculty of Biology, Biology Department, Technion-Israel Institute of Technology, Haifa, Israel
| | - Gil M. Lewitus
- Faculty of Biology, Biology Department, Technion-Israel Institute of Technology, Haifa, Israel
| | - Yelena Vysotski
- Faculty of Biology, Biology Department, Technion-Israel Institute of Technology, Haifa, Israel
| | | | - Anton Ouryvaev
- Department of Oncology, Galilee Medical Center, Nahariya, Israel
| | - Shiri Procaccia
- Faculty of Biology, Biology Department, Technion-Israel Institute of Technology, Haifa, Israel
| | - Idan Cohen
- Cancer Center, HaEmek Medical Center, Afula, Israel
| | - Anca Leibovici
- Department of Oncology, Galilee Medical Center, Nahariya, Israel
| | - Luiza Akria
- Department of Oncology, Galilee Medical Center, Nahariya, Israel
| | | | - Neomi Mativ
- Department of Oncology, Galilee Medical Center, Nahariya, Israel
| | - Avia Kauffman
- Department of Oncology, Galilee Medical Center, Nahariya, Israel
| | - Ayelet Shai
- Department of Oncology, Galilee Medical Center, Nahariya, Israel
- Azrielly Faculty of Medicine, Bar Ilan University, Zafed, Israel
| | - Gil Bar-Sela
- Cancer Center, HaEmek Medical Center, Afula, Israel
- Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - David Meiri
- Faculty of Biology, Biology Department, Technion-Israel Institute of Technology, Haifa, Israel
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25
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Zer A, Icht O, Yosef L, Avram D, Jacobi O, Fenig E, Kurman N, Peretz I, Shamai S, Merimsky O, Ben-Ami E, Shapira Frommer R, Schwarzbach AE, Bernstine H, Weitzen R, Vornicova O, Bar-Sela G, Stemmer SM, Lotem M. Phase 2 single arm study of nivolumab and ipilimumab (Nivo/Ipi) in previously treated classical Kaposi Sarcoma (cKS). Ann Oncol 2022; 33:720-727. [PMID: 35339649 DOI: 10.1016/j.annonc.2022.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 03/12/2022] [Accepted: 03/14/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Classical Kaposi Sarcoma (cKS) is a rare HHV8-associated sarcoma with limited treatment options. We evaluated the efficacy and safety of nivolumab in combination with ipilimumab (Nivo/Ipi) in patients with previously treated progressive cKS. PATIENTS AND METHODS cKS pts with progressive disease after > 1 lines of systemic therapy and measurable disease by PET/CT and/or physical examination received nivolumab 240mg every two weeks and ipilimumab 1mg/kg every six weeks until progression or toxicity for a maximum of 24 months. The primary endpoint was overall response rate (ORR); secondary endpoints included 6-months progression free survival rate (PFS) and safety. Immune correlates were explored using IHC, DNAseq (596/648 genes) and RNAseq (exome capture transcriptome) of tumor specimens and matched blood. RESULTS Eighteen male patients (median age 76.5) were enrolled between April 2018 and Dec 2020. At a median follow up of 24.4 months, ORR by RECIST v1.1 was 87%. Metabolic complete response as assessed by PET CT was observed in 8 of 13 (62%) evaluable patients. 6/13 achieved pathological CR post treatment. In two patients, palliative limb amputation was prevented. Median PFS was not reached. The 6mo and 12m PFS rate was 76.5% and 58.8%, respectively. Only four patients (22%) experienced grade 3-4 adverse events. The most frequent genomic alteration was biallelic copy number loss of FOX1A gene. The majority of tumors carried a low TMB, were microsatellite stable (MSS), MMR proficient, did not express PD-L1 and displayed only low lymphocytic infiltrates, rendering them immunologically "cold". CONCLUSIONS This prospectively designed phase II study of nivolumab and ipilimumab demonstrates promising activity of this combination in progressive cKS representing a new treatment option in this population.
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Affiliation(s)
- A Zer
- Division of Oncology, Rambam Health Care Campus, Israel.
| | - O Icht
- Davidoff Center, Rabin Medical Center, Israel
| | - L Yosef
- Davidoff Center, Rabin Medical Center, Israel
| | - D Avram
- Davidoff Center, Rabin Medical Center, Israel
| | - O Jacobi
- Davidoff Center, Rabin Medical Center, Israel
| | - E Fenig
- Davidoff Center, Rabin Medical Center, Israel
| | - N Kurman
- Davidoff Center, Rabin Medical Center, Israel
| | - I Peretz
- Davidoff Center, Rabin Medical Center, Israel
| | - S Shamai
- Tel Aviv Sourasky Medical Center
| | | | - E Ben-Ami
- Ella Institute for Immuno-Oncology and melanoma, Sheba medical center, Israel
| | - R Shapira Frommer
- Ella Institute for Immuno-Oncology and melanoma, Sheba medical center, Israel
| | | | - H Bernstine
- Nuclear medicine, Rabin Medical Center, Israel
| | - R Weitzen
- Oncology Institute, Sheba Medical Center, Israel
| | | | | | - S M Stemmer
- Davidoff Center, Rabin Medical Center, Israel
| | - M Lotem
- Sharett Institute of Oncology, Hadassah Hebrew University Medical Center
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26
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Khoury M, Cohen I, Bar-Sela G. “The Two Sides of the Same Coin”—Medical Cannabis, Cannabinoids and Immunity: Pros and Cons Explained. Pharmaceutics 2022; 14:pharmaceutics14020389. [PMID: 35214123 PMCID: PMC8877666 DOI: 10.3390/pharmaceutics14020389] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 02/01/2022] [Accepted: 02/04/2022] [Indexed: 02/01/2023] Open
Abstract
Cannabis, as a natural medicinal remedy, has long been used for palliative treatment to alleviate the side effects caused by diseases. Cannabis-based products isolated from plant extracts exhibit potent immunoregulatory properties, reducing chronic inflammatory processes and providing much needed pain relief. They are a proven effective solution for treatment-based side effects, easing the resulting symptoms of the disease. However, we discuss the fact that cannabis use may promote the progression of a range of malignancies, interfere with anti-cancer immunotherapy, or increase susceptibility to viral infections and transmission. Most cannabis preparations or isolated active components cause an overall potent immunosuppressive impact among users, posing a considerable hazard to patients with suppressed or compromised immune systems. In this review, current knowledge and perceptions of cannabis or cannabinoids and their impact on various immune-system components will be discussed as the “two sides of the same coin” or “double-edged sword”, referring to something that can have both favorable and unfavorable consequences. We propose that much is still unknown about adverse reactions to its use, and its integration with medical treatment should be conducted cautiously with consideration of the individual patient, effector cells, microenvironment, and the immune system.
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Affiliation(s)
- Mona Khoury
- Cancer Center, Emek Medical Center, 21 Yitzhak Rabin Blvd, Afula 1834111, Israel; (M.K.); (I.C.)
- Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200002, Israel
| | - Idan Cohen
- Cancer Center, Emek Medical Center, 21 Yitzhak Rabin Blvd, Afula 1834111, Israel; (M.K.); (I.C.)
| | - Gil Bar-Sela
- Cancer Center, Emek Medical Center, 21 Yitzhak Rabin Blvd, Afula 1834111, Israel; (M.K.); (I.C.)
- Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200002, Israel
- Oncology & Hematology Division, Emek Medical Center, Yitshak Rabin Boulevard 21, Afula 1834111, Israel
- Correspondence: ; Tel.: +972-4-6495725; Fax: +972-4-6163992
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Wolf I, Waissengrin B, Zer A, Bernstein-Molho R, Rouvinov K, Cohen JE, Cherny NI, Bar-Sela G. Implementation of the ESMO-Magnitude of Clinical Benefit Scale: real world example from the 2022 Israeli National Reimbursement Process. ESMO Open 2022; 7:100379. [PMID: 35121523 PMCID: PMC8818899 DOI: 10.1016/j.esmoop.2021.100379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 12/07/2021] [Accepted: 12/12/2021] [Indexed: 01/16/2023] Open
Affiliation(s)
- I Wolf
- Division of Oncology, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - B Waissengrin
- Division of Oncology, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - A Zer
- Institiute of Oncology, Rambam Health Campus, Haifa, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - R Bernstein-Molho
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Oncology Division, Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel
| | - K Rouvinov
- The Legacy Heritage Oncology Center, Dr Larry Norton Institute, Soroka Medical Center, and Ben-Gurion University, Beer-Sheva, Israel
| | - J E Cohen
- Sharett Institute of Oncology and The Wohl Institute for Translational Medicine, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - N I Cherny
- Institute of Oncology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - G Bar-Sela
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; Cancer Center, Emek Medical Center, Afula, Israel
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28
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Cohen M, Yagil D, Aviv A, Soffer M, Bar-Sela G. Cancer patients attending treatment during COVID-19: intolerance of uncertainty and psychological distress. J Cancer Surviv 2022; 16:1478-1488. [PMID: 35066775 PMCID: PMC8783796 DOI: 10.1007/s11764-021-01126-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 10/25/2021] [Indexed: 12/16/2022]
Affiliation(s)
- Miri Cohen
- School of Social Work, University of Haifa, 199 Aba Khoushy Ave., Mount Carmel, 3498838, Haifa, Israel.
| | - Dana Yagil
- Department of Human Services, University of Haifa, Haifa, Israel
| | - Ariel Aviv
- Hematology Unit, HaEmek Medical Center, Afula, Israel
| | - Michal Soffer
- School of Social Work, University of Haifa, 199 Aba Khoushy Ave., Mount Carmel, 3498838, Haifa, Israel
| | - Gil Bar-Sela
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Cancer Center, Emek Medical Center, Afula, Israel
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Tur-Sinai A, Urban D, Azoulay D, Bar-Sela G, Bentur N. Understanding out-of-pocket spending and financial hardship among patients who succumb to cancer and their caregivers. Isr J Health Policy Res 2022; 11:1. [PMID: 34980264 PMCID: PMC8722162 DOI: 10.1186/s13584-021-00511-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 12/19/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND In most countries, including those with national health insurance or comprehensive public insurance, some expenses for cancer treatment are borne by the ill and their families. OBJECTIVES This study aims to identify the areas of out-of-pocket (OOP) spending in the last half-year of the lives of cancer patients and examine the extent of that spending; to examine the probability of OOP spending according to patients' characteristics; and to examine the financial burden on patients' families. METHODS 491 first-degree relatives of cancer patients (average age: 70) who died 3-6 months before the study were interviewed by telephone. They were asked about their OOP payments during the last-half year of the patient's life, the nature of each payment, and whether it had imposed a financial burden on them. A logistic regression and ordered logit models were used to estimate the probability of OOP expenditure and the probability of financial burden, respectively. RESULTS Some 84% of cancer patients and their relatives incurred OOP expenses during the last half-year of the patient's life. The average levels of expenditure were US$5800on medicines, $8000 on private caregivers, and $2800 on private nurses. The probability of paying OOP for medication was significantly higher among patients who were unable to remain alone at home and those who were less able to make ends meet. The probability of spending OOP on a private caregiver or private nurse was significantly higher among those who were incapacitated, unable to remain alone, had neither medical nor nursing-care insurance, and were older. The probability of a financial burden due to OOP was higher among those unable to remain alone, the incapacitated, and those without insurance, and lower among those with above-average income, those with better education, and patients who died at home. CONCLUSIONS The study yields three main insights. First, it is crucial that oncology services provide cancer patients with detailed information about their entitlements and refer them to the National Insurance Institute so that they can exercise those rights. Second, oncologists should relate to the financial burden associated with OOP care at end of life. Finally, it is important to sustain the annual increase in budgeting for technologies and pharmaceuticals in Israel and to allocate a significant proportion of those funds to the addition new cancer treatments to the benefits package; this can alleviate the financial burden on patients who need such treatments and their families.
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Affiliation(s)
- Aviad Tur-Sinai
- Department of Health Systems Management, The Max Stern Yezreel Valley College, 1930600 Yezreel Valley, Israel
- School of Nursing, University of Rochester Medical Center, Rochester, NY USA
| | - Damien Urban
- Department of Oncology, Sheba Medical Center, Tel Hashomer, Israel
| | - Daniel Azoulay
- Unit for Palliative Care, Hadassah Medical Center, Mount Scopus, Jerusalem, Israel
| | - Gil Bar-Sela
- Oncology and Hematology Division, Emek Medical Center, Afula, Israel
| | - Netta Bentur
- The Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Lutsyk M, Turgeman I, Bar-Sela G. Rapid Initiation of Neoadjuvant Chemoradiotherapy After Diagnosis is Associated With Improved Pathologic Response in Locally Advanced Rectal Cancer. Am J Clin Oncol 2022; 45:1-8. [PMID: 34857697 DOI: 10.1097/coc.0000000000000872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
INTRODUCTION In rectal cancer, neoadjuvant chemoradiation (NCRT) is preferred because of toxicity profile, improved resectability and sphincter preservation, although with no impact on overall survival. Pathologic complete response (pCR) to NCRT has been linked with longer disease-free survival (DFS). The study purpose was to evaluate an association between clinical factors and treatment schedule with tumor response and treatment outcome, among patients with locally advanced rectal cancer. PATIENTS AND METHODS In this single-center retrospective study, conducted over 9 years (2011 to 2020), patients with stage II to III rectal cancer who had received NCRT were enrolled. The standard radiotherapy was 45 Gy to the pelvis, with a simultaneous integrated 50 Gy boost to the primary tumor. Continuous 5-Fluorouracil or oral capecitabine was administered concurrently. Surgery was preplanned within 6 to 8 weeks. Multinomial logistic regressions for evaluation of clinical factors, Kaplan-Meier method for DFS estimation, and receiver operating characteristic analysis for determination of the optimal timeframe were used. RESULTS Of 279 cases, pCR was observed in 72 (25.8%). In 207 cases, pTis-4N-negative was obtained in 137 (66.2%), pT0N-positive in 6 (2.9%), and pTis-4N-positive in 64 (30.9%). The pCR group had shorter diagnosis-NCRT time (P<0.01) and on-treatment time (P=0.05). DFS was longer for pCR and partial responders with clinical stage II and III (P<0.0001). Diagnosis-NCRT time was shown different between pCR and non-pCR groups. receiver operating characteristic analysis (P<0.01) showed that a diagnosis-NCRT time of <4.5 weeks predicts pCR with a sensitivity of 88% and specificity of 81% accuracy. CONCLUSION The time elapsed between rectal cancer diagnosis and NCRT initiation is significantly associated with pCR. Reducing this time may increase the probability of achieving pCR.
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Affiliation(s)
| | | | - Gil Bar-Sela
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa
- Cancer Center, Emek Medical Center, Afula, Israel
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Hijab A, Taha T, Charas T, Bar-Sela G, Stein P, Agbarya A. Anti-androgen for myoepithelial tumor: a potent therapy yet a potential misleader. Anticancer Drugs 2022; 33:e747-e751. [PMID: 34387605 DOI: 10.1097/cad.0000000000001175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Myoepithelial tumor is a rare form of cancer, mainly arising from the salivary glands and extremities. Due to its rarity, no formal treatment guidelines exist. Here we report a case of a male patient diagnosed with metastatic myoepithelial tumor which was successfully treated with an androgen-receptor (AR) antagonist (bicalutamide), based on the results of molecular testing. Six years after the initiation of bicalutamide, patient was diagnosed with metastatic prostate cancer. To our knowledge, this is the first case described in literature that demonstrate the effectiveness of anti-androgens in treating myoepithelial tumor. Vigilance should be maintained when screening these patients for prostate cancer as their 'true' prostate specific antigen levels might be masked by the ongoing endocrine therapy.
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Affiliation(s)
- Adham Hijab
- Division of Oncology, Rambam Health Care Center, Haifa
| | - Tarek Taha
- Division of Oncology, Rambam Health Care Center, Haifa
| | - Tomer Charas
- Division of Oncology, Rambam Health Care Center, Haifa
| | | | - Polina Stein
- Department of Pathology, Rambam Health Care Center, Haifa
| | - Abed Agbarya
- Institute of Oncology, Bnai Zion Medical Center, Haifa, Israel
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Sachar-Raf E, Bar-Sela G. [PROLONGED COMPLETE REMISSION AFTER A SHORT COURSE OF HEDGEHOG PATHWAY INHIBITORS IN PATIENTS WITH ADVANCED BASAL CELL CARCINOMA: AN ALTERNATIVE TO SURGERY?]. Harefuah 2022; 161:34-38. [PMID: 35077058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Basal cell carcinoma (BCC) is a cancer that arises from the basal layer of the epidermis and is most often caused by exposure to UV radiation. Most BCCs are localized and can be fully treated by surgical removal or topical treatment. In the last decade, it has been found that the hedgehog pathway, a signaling pathway that regulates embryonic development, has a pivotal role in the pathogenesis of BCC in adults. Therefore, two drugs that inhibit the hedgehog pathway have been developed. These drugs, indicated for metastatic or locally advanced BCC, may cause a rapid clinical and imaging response, but have an adverse reaction that includes muscle spasms, alopecia, dysgeusia and fatigue, and often leads to drug discontinuation. Due to the high rates of treatment discontinuation, the possibility of administering the drug intermittently was examined and, indeed, a decrease in adverse reactions together with tumor response was observed. Additionally, it seems that patients who discontinue treatment may benefit from long-term remission. These cases indicate the possibility of changing the schedule of administration of the drug. We hereby report two cases of patients who were treated with radiation therapy for ringworm in their childhood and developed BCC. The patients were treated with a hedgehog pathway inhibitor with complete tumor regression. After treatment was discontinued due to adverse reactions, no recurrence of the tumor was observed over a period of almost two years.
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Affiliation(s)
| | - Gil Bar-Sela
- Cancer Center, Emek Medical Center, Afula
- Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa
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Bar-Sela G, Mermershtain W. [REVIEW OF SOME OF THE RECENT DEVELOPMENTS IN ONCOLOGY TREATMENT IN THE LAST DECADE]. Harefuah 2022; 161:6-8. [PMID: 35077051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
For the last two years, the medical world has been focused on the COVID-19 pandemic. Most health organizations throughout the world agree that this pandemic will disappear or become less virulent in the coming years, like most viral infectious diseases. While the focus of the medical authorities in Israel changed in the last two years, cancer diseases remained the leading cause of death in Israel. Nevertheless, the percentage of cancer survivors is rising slowly in the Western world, as well as in Israel. Some of these wonderful achievements are related to new technologies in cancer diagnosis and treatment, together with completely new treatment strategies based on innovative medications that entered the treatment of oncology in the last decade. In this edition of "Harefuah", dedicated to oncology, we will present some examples of the new paradigms in the treatment of cancer diseases, described in research articles, case reports and reviews.
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Affiliation(s)
- Gil Bar-Sela
- Cancer Center, Emek Medical Center, Afula
- Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa
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34
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Hirsh-Yechezkel G, Chetrit A, Ben Avraham S, Agbarya A, Yakobson A, Asna N, Bar-Sela G, Ben-Aharon I, Ben-Baruch NE, Berger R, Brenner R, Gottfried M, Paluch-Shimon S, Pfeffer R, Popovtzer A, Ryvo L, Semenisty V, Shai A, Shulman K, Zidan J, Wolf I. Oncology Treatments during the COVID-19 Pandemic in Israel: the ONCOR Study. Isr Med Assoc J 2021; 23:759-765. [PMID: 34954913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND The increased susceptibility of cancer patients to coronavirus disease-2019 (COVID-19) infections and complications calls for special precautions while treating cancer patients during COVID-19 pandemics. Thus, oncology departments have had to implement a wide array of prevention measures. OBJECTIVES To address issues associated with cancer care during the COVID-19 pandemic and to assess the implementation of measures aimed at containment of COVID-19 diffusion while allowing continuation of quality cancer care. METHODS A national survey among oncology departments in Israel was conducted between 12 April 2020 and 14 April 2020. Eighteen heads of hospital-based oncology departments completed a self-report questionnaire regarding their institute's preparedness for treatment of cancer patients during the COVID-19 pandemic. RESULTS In this national survey, prevention measures against COVID-19 spread were taken prior to patients' arrival and at arrival or while staying in the departments. Most participants (78-89%) reported using a quick triage of patients and caregivers prior to their entrance to the oncology units, limiting the entrance of caregivers, and reducing unnecessary visits to the clinic. Switching to oral therapies rather than intravenous ones when possible was considered by 82% and shortage in personal protective equipment was reported by five (28%) heads of oncology departments. Some differences between large and small/medium sized medical centers were observed regarding issues related to COVID-19 containment measures and changes in treatment. CONCLUSIONS Oncology departments in Israel were able to prepare and adapt their services to guidelines and requirements related to the COVID-19 pandemic with little harm to their treatment capacity.
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Affiliation(s)
- Galit Hirsh-Yechezkel
- Cancer and Radiation Epidemiology Unit, affiliated with Tel Aviv University, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel
| | - Angela Chetrit
- Cancer and Radiation Epidemiology Unit, affiliated with Tel Aviv University, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel
| | - Sivan Ben Avraham
- Cancer and Radiation Epidemiology Unit, affiliated with Tel Aviv University, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel
| | - Abed Agbarya
- Department of Oncology, Bnai Zion Medical Center, Haifa, Israel
| | - Alexander Yakobson
- Legacy Heritage Oncology Center and Norton Institute, Soroka Medical Center, Beer Sheva, Israel
- Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Noam Asna
- Department of Oncology Ziv Medical Center, Safed, Israel
| | - Gil Bar-Sela
- Cancer Center, Emek Medical Center, Afula, Israel
| | - Irit Ben-Aharon
- Division of Oncology, Rambam Health Care Campus, Haifa, Israel
- Rappaport Faculty of Medicine, Technion-Institute of Technology, Haifa, Israel
| | - Noa Efrat Ben-Baruch
- Department of Oncology, Kaplan Medical Center, Rehovot, Israel
- Department of Oncology, Nazareth Hospital, Nazareth, Israel
| | - Raanan Berger
- Cancer Center, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ronen Brenner
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Oncology Institute, Wolfson Medical Center, Holon, Israel
| | - Maya Gottfried
- Department of Oncology, Meir Medical Center, Kfar Saba, Israel
| | - Shani Paluch-Shimon
- Division of Oncology, Shaare Zedek Medical Center, Jerusalem, Israel
- Division of Oncology, Hadassah University Hospital, Jerusalem, Israel
| | - Raphael Pfeffer
- Ben Gurion University of the Negev, Beer Sheva, Israel
- Oncology Institute, Assuta Medical Center, Tel Aviv, Israel
| | - Aron Popovtzer
- Oncology Institute, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Larisa Ryvo
- Department of Oncology, Assuta Ashdod Academic Medical Center, Ashdod, Israel
| | | | - Ayelet Shai
- Department of Oncology, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Katerina Shulman
- Rappaport Faculty of Medicine, Technion-Institute of Technology, Haifa, Israel
- Oncology Unit, Carmel Medical Center, Haifa, Israel
| | - Jamal Zidan
- Department of Oncology Ziv Medical Center, Safed, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Ido Wolf
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Oncology Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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Abrams DI, Velasco G, Twelves C, Ganju RK, Bar-Sela G. Cancer Treatment: Preclinical & Clinical. J Natl Cancer Inst Monogr 2021; 2021:107-113. [PMID: 34850894 DOI: 10.1093/jncimonographs/lgab010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 09/10/2021] [Indexed: 11/13/2022] Open
Abstract
The first evidence that cannabinoids may have in vitro and in vivo antineoplastic activity against tumor cell lines and animal tumor models was published in the Journal of the National Cancer Institute nearly 50 years ago. Cannabinoids appear to induce apoptosis in rodent brain tumors by way of direct interaction with the cannabinoid receptor. They may inhibit angiogenesis and tumor cell invasiveness. Despite preclinical findings, attempts to translate the benefits from bench to bedside have been limited. This session provides a review of the basic science supporting the use of cannabinoids in gliomas, paired with the first randomized clinical trial of a cannabis-based therapy for glioblastoma multiforme. Another preclinical presentation reports the effects of cannabinoids on triple-negative breast cancer cell lines and how cannabidiol may affect tumors. The session's second human trial raises concerns about the use of botanical cannabis in patients with advanced cancer receiving immunotherapy suggesting inferior outcomes.
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Affiliation(s)
- Donald I Abrams
- Hematology-Oncology Division, Department of Medicine, University of California, San Francisco, CA, USA
| | - Guillermo Velasco
- Department of Biochemistry and Molecular Biology, School of Biology, Complutense University, Madrid, Spain.,Group of Cannabinoid Signaling in Cancer Cells, Division of Oncology Research, Instituto de Investigación Sanitaria San Carlos, Madrid, Spain
| | - Chris Twelves
- Department of Oncology, University of Leeds and Leeds Teaching Hospitals Trust, Leeds, England, UK
| | - Ramesh K Ganju
- Department of Pathology, Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Gil Bar-Sela
- Oncology and Hematology Division, Cancer Center, Emek Medical Center, Afula,Israel.,Bruce Rappaport Faculty of Medicine, Technion/Israel Institute of Technology, Haifa, Israel
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36
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Turgeman I, Bar-Sela G. Reply to D.B. Scarpelli et al. JCO Oncol Pract 2021; 17:645-646. [PMID: 34436953 DOI: 10.1200/op.21.00487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Ilit Turgeman
- Ilit Turgeman, MD, Division of Oncology, Rambam Health Care Campus, Haifa, Israel and Gil Bar-Sela, MD, Cancer Center, Emek Medical Center, Afula, Israel, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Gil Bar-Sela
- Ilit Turgeman, MD, Division of Oncology, Rambam Health Care Campus, Haifa, Israel and Gil Bar-Sela, MD, Cancer Center, Emek Medical Center, Afula, Israel, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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37
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Bar-Sela G, Bagon S, Mitnik I, Adi S, Baziliansky S, Bar-Sella A, Vornicova O, Tzuk-Shina T. The perception and attitudes of Israeli cancer patients regarding advance care planning. J Geriatr Oncol 2021; 12:1181-1185. [PMID: 34049836 DOI: 10.1016/j.jgo.2021.05.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 03/11/2021] [Accepted: 05/19/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Advance care planning (ACP) allows patients to acknowledge and document their preferences regarding end-of-life care and to ensure their fulfilment. Several factors were found to be related to patients' motivation regarding this process, such as their fear of being a burden on family members; however, the completion rate of the ACP forms is partial. The current study aimed to evaluate the barriers and motives among Israeli cancer patients regarding ACP, including many older adults. SETTING AND MEASUREMENTS Advanced cancer patients participated in the study. All completed an initial questionnaire to evaluate their basic knowledge regarding the issue. Participants who agreed to talk with a social worker completed a semi open-ended questionnaire which investigated their main motives and barriers regarding the issue. RESULTS Most of the patients who completed the ACP forms were older and had lung cancer. They mentioned information and open communication with family and staff members as the main enabling factors. Their main motives were to ensure that the best medical decisions would be made and to avoid unnecessary medical procedures. The main reasons for not completing the forms was no close relative who would agree to take the responsibility as well as timing. Most of the participants did not hear about the issue from sources outside the oncology division. CONCLUSIONS Despite several limitations, the current findings may have important implications regarding ways to establish a more suitable ACP process, adjusted to older patients' needs. This may assist in promoting patients' cooperation with ACP and its implementation in the medical system, including older adults.
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Affiliation(s)
- Gil Bar-Sela
- Division of Oncology & Hematology, Emek Medical Center, Afula, Israel.
| | - Shlomit Bagon
- Division of Oncology, Rambam Health Care Campus, Haifa, Israel.
| | - Inbal Mitnik
- Division of Oncology, Rambam Health Care Campus, Haifa, Israel.
| | - Shay Adi
- Division of Oncology & Hematology, Emek Medical Center, Afula, Israel.
| | | | | | - Olga Vornicova
- Division of Oncology & Hematology, Emek Medical Center, Afula, Israel.
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Abstract
PURPOSE: Emergency cancer care constitutes a significant health care and patient burden. The purpose of this study was to identify characteristics of patients most fitting for treatment in an oncology-dedicated emergency department (OED). METHODS: Electronic files of patients with cancer seeking emergency services between April and June 2017 were retrospectively obtained from the hospital registry. Efficacy parameters were compared between patients treated in the OED and those treated in the general emergency department (GED). Using descriptive statistics and logistic regressions, patient- and treatment-related factors were correlated with effective care in the OED. RESULTS: More than half of the total 799 patients presented initially to the OED, of which 10.4% required GED referral. Treatment in the GED was associated with a higher rate of consultations, imaging, and hospitalization (P < .001), with the cost of imaging alone four times that of the OED ($23,263 US dollars difference). The relative proportion of patients with cancer visiting the GED was reduced after founding the OED. In the OED, patient diagnoses included lung (33%), GI, and breast cancer, of which 85% were metastatic. Frequent chief complaints were pain (45%), GI, malaise, and respiratory symptoms. Referral to the GED was significant in those with genitourinary cancer, back pain (P < .001), and neurologic symptoms, on biologic therapy, and with suspected oncological emergencies; conversely, disease symptoms (30% admissions) were well-controlled in the OED (P = .003). CONCLUSION: Using minimal resources, the OED provides efficacious, cancer-focused care, suitable for the majority of acute admissions. Careful triage is recommended, as high-risk patients should be referred to the GED, where advanced multidisciplinary management is more readily available.
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Affiliation(s)
- Ilit Turgeman
- Division of Oncology, Rambam Health Care Campus, Haifa, Israel
| | - Gil Bar-Sela
- Cancer Center, Emek Medical Center, Afula, Israel.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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39
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Abu-Amna M, Salti T, Khoury M, Cohen I, Bar-Sela G. Medical Cannabis in Oncology: a Valuable Unappreciated Remedy or an Undesirable Risk? Curr Treat Options Oncol 2021; 22:16. [PMID: 33439370 DOI: 10.1007/s11864-020-00811-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2020] [Indexed: 01/11/2023]
Abstract
OPINION STATEMENT The use of the cannabis plant by cancer patients has been rising significantly in the past few years worldwide, primarily driven by public demand. There is an obvious need for more reliable scientific data, pharmacology information, a better understanding of its mode of action, and available clinical evidence supporting its robust use. Physicians must complete a thorough medical assessment, screening for potential drugs, or treatment contraindications before allowing its consumption. In light of the growing popularity of cannabis usage, it is highly essential that, in the near future, the medical community will be able to provide practical recommendations and explicit guidelines, including doses, and that cannabinoid concentrations in the used products are defined regarding its prescription before any medical procedure involving its usage is authorized. Here, we review and describe the favorable outcomes demonstrating the benefits of cannabis as an adjunctive treatment to conventional medicines for chemotherapy-induced nausea, vomiting, and cancer-related pain (primarily refractory chronic or neuropathic pain). Although not yet substantial enough, the treatment of anorexia, insomnia, depression, and anxiety is also seemingly favorable. To date, reports regarding its anti-neoplastic effects or its potent immunosuppressive properties influencing response to immunotherapy are still very conflicting and controversial. Thus, with the current state of evidence, cannabis use is not advisable as initial treatment, as an adjunct or an advanced line of care. In the coming years, we expect that preclinical data and animal models will shift to the clinical arena, and more patients will be recruited for clinical trials, and their reports will advance the field. Thus, physicians should prescribe cannabis only if careful clarification and consideration is provided together with a follow-up response evaluation.
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Affiliation(s)
- Mahmoud Abu-Amna
- Cancer Center, Emek Medical Center, 21 Yitzhak Rabin Blvd, 1834111, Afula, Israel
| | - Talal Salti
- Cancer Center, Emek Medical Center, 21 Yitzhak Rabin Blvd, 1834111, Afula, Israel.,Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, 320002, Haifa, Israel
| | - Mona Khoury
- Cancer Center, Emek Medical Center, 21 Yitzhak Rabin Blvd, 1834111, Afula, Israel.,Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, 320002, Haifa, Israel
| | - Idan Cohen
- Cancer Center, Emek Medical Center, 21 Yitzhak Rabin Blvd, 1834111, Afula, Israel
| | - Gil Bar-Sela
- Cancer Center, Emek Medical Center, 21 Yitzhak Rabin Blvd, 1834111, Afula, Israel. .,Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, 320002, Haifa, Israel.
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40
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Aviram J, Lewitus GM, Vysotski Y, Uribayev A, Procaccia S, Cohen I, Leibovici A, Abo-Amna M, Akria L, Goncharov D, Mativ N, Kauffman A, Shai A, Hazan O, Bar-Sela G, Meiri D. Short-Term Medical Cannabis Treatment Regimens Produced Beneficial Effects among Palliative Cancer Patients. Pharmaceuticals (Basel) 2020; 13:ph13120435. [PMID: 33265945 PMCID: PMC7761379 DOI: 10.3390/ph13120435] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 11/25/2020] [Accepted: 11/27/2020] [Indexed: 12/14/2022] Open
Abstract
In the last decade the use of medical cannabis (MC) for palliative cancer treatment has risen. However, the choice between products is arbitrary and most patients are using Tetrahydrocannabinol (THC)-dominant cannabis products. In this study, we aimed to assess the short-term outcomes of MC treatment prescribed by oncologists in relation to the type of cannabis they receive. A comparative analysis was used to assess the differences in treatment effectiveness and safety between THC-dominant (n = 56, 52%), cannabidiol (CBD)-dominant (n = 19, 18%), and mixed (n = 33, 30%) MC treatments. Oncology patients (n = 108) reported on multiple symptoms in baseline questionnaires, initiated MC treatment, and completed a one-month follow-up. Most parameters improved significantly from baseline, including pain intensity, affective and sensory pain, sleep quality and duration, cancer distress, and both physical and psychological symptom burden. There was no significant difference between the three MC treatments in the MC-related safety profile. Generally, there were no differences between the three MC treatments in pain intensity and in most secondary outcomes. Unexpectedly, CBD-dominant oil treatments were similar to THC-dominant treatments in their beneficial effects for most secondary outcomes. THC-dominant treatments showed significant superiority in their beneficial effect only in sleep duration compared to CBD-dominant treatments. This work provides evidence that, though patients usually consume THC-dominant products, caregivers should also consider CBD-dominant products as a useful treatment for cancer-related symptoms.
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Affiliation(s)
- Joshua Aviram
- Faculty of Biology, Technion-Israel Institute of Technology, Haifa 32000, Israel; (J.A.); (G.M.L.); (Y.V.); (S.P.); (O.H.)
| | - Gil M. Lewitus
- Faculty of Biology, Technion-Israel Institute of Technology, Haifa 32000, Israel; (J.A.); (G.M.L.); (Y.V.); (S.P.); (O.H.)
| | - Yelena Vysotski
- Faculty of Biology, Technion-Israel Institute of Technology, Haifa 32000, Israel; (J.A.); (G.M.L.); (Y.V.); (S.P.); (O.H.)
| | - Anton Uribayev
- Department of Oncology, Galilee Medical Center, Nahariya 22100, Israel; (A.U.); (A.L.); (L.A.); (D.G.); (N.M.); (A.K.); (A.S.)
| | - Shiri Procaccia
- Faculty of Biology, Technion-Israel Institute of Technology, Haifa 32000, Israel; (J.A.); (G.M.L.); (Y.V.); (S.P.); (O.H.)
| | - Idan Cohen
- Cancer Center, Emek Medical Center, Afula 18101, Israel; (I.C.); (M.A.-A.)
| | - Anca Leibovici
- Department of Oncology, Galilee Medical Center, Nahariya 22100, Israel; (A.U.); (A.L.); (L.A.); (D.G.); (N.M.); (A.K.); (A.S.)
| | - Mahmud Abo-Amna
- Cancer Center, Emek Medical Center, Afula 18101, Israel; (I.C.); (M.A.-A.)
| | - Luiza Akria
- Department of Oncology, Galilee Medical Center, Nahariya 22100, Israel; (A.U.); (A.L.); (L.A.); (D.G.); (N.M.); (A.K.); (A.S.)
| | - Dmitry Goncharov
- Department of Oncology, Galilee Medical Center, Nahariya 22100, Israel; (A.U.); (A.L.); (L.A.); (D.G.); (N.M.); (A.K.); (A.S.)
| | - Neomi Mativ
- Department of Oncology, Galilee Medical Center, Nahariya 22100, Israel; (A.U.); (A.L.); (L.A.); (D.G.); (N.M.); (A.K.); (A.S.)
| | - Avia Kauffman
- Department of Oncology, Galilee Medical Center, Nahariya 22100, Israel; (A.U.); (A.L.); (L.A.); (D.G.); (N.M.); (A.K.); (A.S.)
| | - Ayelet Shai
- Department of Oncology, Galilee Medical Center, Nahariya 22100, Israel; (A.U.); (A.L.); (L.A.); (D.G.); (N.M.); (A.K.); (A.S.)
| | - Or Hazan
- Faculty of Biology, Technion-Israel Institute of Technology, Haifa 32000, Israel; (J.A.); (G.M.L.); (Y.V.); (S.P.); (O.H.)
| | - Gil Bar-Sela
- Cancer Center, Emek Medical Center, Afula 18101, Israel; (I.C.); (M.A.-A.)
- Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 32000, Israel
- Correspondence: (G.B.-S.); (D.M.); Tel.: +972-4-6495723 (G.B.-S.); +972-77-8871680 or +972-525330031 (D.M.)
| | - David Meiri
- Faculty of Biology, Technion-Israel Institute of Technology, Haifa 32000, Israel; (J.A.); (G.M.L.); (Y.V.); (S.P.); (O.H.)
- Correspondence: (G.B.-S.); (D.M.); Tel.: +972-4-6495723 (G.B.-S.); +972-77-8871680 or +972-525330031 (D.M.)
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Bar-Sela G, Cohen I, Avisar A, Loven D, Aharon A. Circulating blood extracellular vesicles as a tool to assess endothelial injury and chemotherapy toxicity in adjuvant cancer patients. PLoS One 2020; 15:e0240994. [PMID: 33108394 PMCID: PMC7591065 DOI: 10.1371/journal.pone.0240994] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 10/06/2020] [Indexed: 01/08/2023] Open
Abstract
Extracellular vesicles (EVs) are subcellular membrane blebs that include exosomes and microparticles, which represent a potential source for cancer biomarker discovery. We assess EVs characteristics as a tool to evaluate the endothelial and anti-tumor treatment injury during adjuvant chemotherapy in breast (BC) and colon cancer (CC) patients. Blood samples were taken from 29 BC and 25 CC patients before and after chemotherapy, as well as from healthy control donors (HC). Circulating blood EVs were isolated and characterized by size/concentration, membrane antigens for cell origin, thrombogenicity, and protein content. We observed higher EVs concentration and particle size in CC patients after chemotherapy compared with HC. Higher levels of endothelial EVs (CD144-positive) and vascular endothelial growth factor receptor 1 (VEGFR1), apparently as an indication of endothelial dysfunction, were found in all cancer patients, regardless of a given treatment, compared to HC. Levels of EVs labeled CD62E, CD34+41-, the lymphocyte markers CD11+ and CD-14+, Annexin-V, and the coagulation proteins TF and TFPI, however, sometimes demonstrate significant differences between patients, although HC did not show significant differences between patients pre- and post-chemotherapy. Most importantly, increasing levels of EVs encapsulated Angiostatin were found in patients with CC, while chemotherapy treatment leads to its notable rise in circulating blood EVs. Our results demonstrate the potential of EVs encapsulated Angiostatin as a tool to evaluate endothelial damage during adjuvant chemotherapy in BC and CC patients.
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Affiliation(s)
- Gil Bar-Sela
- Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Cancer Center, Emek Medical Center, Afula, Israel
| | - Idan Cohen
- Cancer Center, Emek Medical Center, Afula, Israel
| | | | - David Loven
- Cancer Center, Emek Medical Center, Afula, Israel
| | - Anat Aharon
- Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Hematology and Bone Marrow Transplantation, Sourasky Medical Center, Tel Aviv, Israel
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Avisar A, Cohen M, Brenner B, Bronshtein T, Machluf M, Bar-Sela G, Aharon A. Extracellular Vesicles Reflect the Efficacy of Wheatgrass Juice Supplement in Colon Cancer Patients During Adjuvant Chemotherapy. Front Oncol 2020; 10:1659. [PMID: 32984039 PMCID: PMC7479215 DOI: 10.3389/fonc.2020.01659] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 07/28/2020] [Indexed: 12/12/2022] Open
Abstract
Introduction Colorectal cancer (CC) is the third most common type of cancer, accounting for 10% of all cancer cases. Adjuvant chemotherapy is recommended in stages II–III CC. Wheatgrass juice (WGJ) from wheat seeds has high nutritional values, may induce synergistic benefits to chemotherapy and may attenuate chemotherapy-related side effects. Extracellular vesicles (EVs) are subcellular membrane blebs. EVs include exosomes (generated in the endosome, in size <150 nm) and microvesicles (shed from the plasma cell membrane) provide information on their parental cells and play a role in intercellular communication. We aimed to elucidate the effects of chemotherapy administration with supportive treatment of WGJ on CC patients’ EVs characteristics. Methods EVs were isolated from the blood samples of 15 healthy controls (HCs) and 50 CC patients post-surgery, treated by chemotherapy, with or without additional daily WGJ. Blood samples were taken before, during, and at the end of chemotherapy. EVs were characterized by size, concentration, membrane antigens and cytokine content using nanoparticle-tracking analysis, western blot, flow cytometry, and protein array methods. Results EVs were found to be similar by size and concentration with reduced levels of exosome markers (CD81) on samples at the end of combined treatment (chemotherapy and WGJ). Higher levels of endothelial EVs, which may indicate impairment of the vascular endothelial cells during treatment, were found in CC patients treated by chemotherapy only compared to those with chemotherapy and daily WGJ. Also, EVs thrombogenicity was lower in patients added WGJ compared to patients who had only chemotherapy (levels of tissue factor p = 0.029 and endothelial protein C receptor p = 0.005). Following treatments, levels of vascular endothelial growth factor receptors (VEGFR-1) and the majority of growth-factors/pro-inflammatory cytokines were higher in EVs of patients treated by chemotherapy only than in EVs obtained from patients with the combined treatment. Conclusion Daily consumption of WGJ during chemotherapy may reduce vascular damage and chemotherapy-related thrombogenicity, growth factors and cytokines, as reflected by the characteristics of patient’s EVs.
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Affiliation(s)
- Adva Avisar
- The Graduate Studies Authority, University of Haifa, Haifa, Israel
| | - Miri Cohen
- School of Social Work, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Benjamin Brenner
- Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel.,Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Tomer Bronshtein
- The Lab for Cancer Drug Delivery & Cell Based Technologies, The Faculty of Biotechnology and Food Engineering, Technion - Israel Institute of Technology, Haifa, Israel
| | - Marcelle Machluf
- The Lab for Cancer Drug Delivery & Cell Based Technologies, The Faculty of Biotechnology and Food Engineering, Technion - Israel Institute of Technology, Haifa, Israel
| | - Gil Bar-Sela
- Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Cancer Center, Emek Medical Center, Afula, Israel
| | - Anat Aharon
- Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel.,Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Hematology Research Laboratory, Hematology and Bone Marrow Transplantation, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Ivzori-Erel A, Bar-Sela G, Cohen M. Introducing the concept sense of place: A mediator between place of care and emotional distress of patients with cancer at the end of life. Psychooncology 2020; 29:1951-1958. [PMID: 32856351 DOI: 10.1002/pon.5530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/03/2020] [Accepted: 08/06/2020] [Indexed: 01/29/2023]
Abstract
BACKGROUND A sense of place (SOP) is defined as the emotional bonds, values, meaning, and symbols attached to a place. AIM To assess SOP of patients with cancer during end-of-life care at home (home-hospice service) versus at a hospital in relation to place of care, social support, and emotional distress. METHODS Participants were 150, stage IV, cancer patients with a life expectancy of less than 6 months, as defined by oncological staff, who were not receiving any life-prolonging care. Seventy-five patients received care at home (home-hospice), and the other 75 received care at the oncology department at the hospital, by palliative unit staff. Participants completed the Brief Symptom Inventory anxiety and depression subscales, questionnaires on perceived support and both questionnaires on home SOP and hospital SOP. RESULTS Mean scores of emotional distress were similar for patients in home-hospice and at the hospital. Home SOP among individuals receiving care at home was high, and hospital SOP was high among hospitalized individuals. The structural equation model had good fit indexes, showing that each of the SOP variables mediated the association between place of care and emotional distress. Perceived support was associated with lower distress only in the hospital setting. CONCLUSIONS The SOP concept is relevant to understanding emotional distress in relation to place of care at end of life. Strengthening SOP in relation to place of care should be considered. As newly introduced concept regarding place of care at the EoL, SOP warrants further research.
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Affiliation(s)
- Adi Ivzori-Erel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Department of Family Medicine, Clalit Health Services, Haifa, Israel
| | - Gil Bar-Sela
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Cancer Center, Emek Medical Center, Afula, Israel
| | - Miri Cohen
- School of Social Work, University of Haifa, Haifa, Israel
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Bar-Sela G, Choen I, Campisi-Pinto S, Lewitus G, Oz-Ari L, Jehassi A, Peer A, Turgeman I, Vernicova O, Berman P, Wollner M, Moskovitz M, Meiri D. 1852P Chronic cannabis used by patients with advanced cancer during Immunotherapy initiation: clinical outcomes and endocannabinoid levels evaluation. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Salti T, Khazim K, Haddad R, Campisi-Pinto S, Bar-Sela G, Cohen I. Glucose Induces IL-1α-Dependent Inflammation and Extracellular Matrix Proteins Expression and Deposition in Renal Tubular Epithelial Cells in Diabetic Kidney Disease. Front Immunol 2020; 11:1270. [PMID: 32733443 PMCID: PMC7358427 DOI: 10.3389/fimmu.2020.01270] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 05/19/2020] [Indexed: 12/13/2022] Open
Abstract
Diabetes mellitus is linked with metabolic stress that induces cellular damage and can provoke renal inflammation and fibrotic responses that eventually lead to chronic kidney disease. Because the inflammasome, interleukin 1 (IL-1), IL-1α/IL-β, and IL-1R are central elements of kidney inflammation and pharmacological IL-1R antagonist (IL-1Ra) was shown to prevent or even reverse diabetic nephropathy (DN) in animal models, we explored the intrinsic expression of IL-1 molecules in kidney tissue of DN patients as regulators of renal inflammation. We used biopsies taken from DN patients and controls and show a high level of IL-1α expression in renal tubular epithelial cells, whereas both IL-1 agonistic molecules (i.e., IL-1α and IL-1β) were devoid of the glomeruli. Human proximal tubular kidney HK-2 cells exposed to high glucose (HG) gradually increase the expression of IL-1α but not IL-1β and induce the expression and deposition of extracellular matrix (ECM) proteins. We further demonstrate that in vitro ectopic addition of recombinant IL-1α in low glucose concentration leads to a similar effect as in HG, while supplementing excess amounts of IL-1Ra in HG significantly attenuates the ECM protein overexpression and deposition. Accordingly, inhibition of IL-1α cleaving protease calpain, but not caspapse-1, also strongly reduces ECM protein production by HK-2 cells. Collectively, we demonstrate that IL-1α and not IL-1β, released from renal tubular cells is the key inflammatory molecule responsible for the renal inflammation in DN. Our result suggests that the clinical use of IL-1Ra in DN should be promoted over the individual neutralization of IL-1α or IL-1β in order to achieve better blocking of IL-1R signaling.
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Affiliation(s)
- Talal Salti
- Galilee Medical Center, Research Institute, Nahariya, Israel
| | - Khaled Khazim
- Galilee Medical Center, Research Institute, Nahariya, Israel.,Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.,Department of Nephrology and Hypertension, Galilee Medical Center, Nahariya, Israel
| | - Rami Haddad
- Galilee Medical Center, Research Institute, Nahariya, Israel
| | | | - Gil Bar-Sela
- Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Cancer Center, Emek Medical Center, Afula, Israel
| | - Idan Cohen
- Cancer Center, Emek Medical Center, Afula, Israel
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Avisar A, Cohen M, Katz R, Shentzer Kutiel T, Aharon A, Bar-Sela G. Wheatgrass Juice Administration and Immune Measures during Adjuvant Chemotherapy in Colon Cancer Patients: Preliminary Results. Pharmaceuticals (Basel) 2020; 13:E129. [PMID: 32585974 PMCID: PMC7345549 DOI: 10.3390/ph13060129] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/14/2020] [Accepted: 06/19/2020] [Indexed: 12/12/2022] Open
Abstract
Adjuvant chemotherapy is recommended in high-risk stage II-III colorectal cancer (CC). We examine the effect of daily wheatgrass juice (WGJ) intake in addition to chemotherapy on immune parameters, including IL-6, IL-8, IL-10, IL-12, and white blood cells (WBCs) among CC patients. In a controlled prospective trial, 100 stage II-III CC patients were enrolled. According to patient preference, they were divided into two subgroups, control group and intervention group, 50 patients each, all of whom received the same standard postoperative adjuvant chemotherapy, plus consumption of 60 cc WGJ daily in the intervention group. Blood samples were collected at baseline (T0) and upon treatment termination, 5-6 months later (T1). Cytokine concentrations were assessed using ELISA kits. Anti-inflammatory cytokine IL-10 concentrations were significantly higher in the WGJ group than in the control group at T1. The decline in WBC counts between T0 and T1 was significantly lower in the WGJ group. No significant differences were observed in IL-6, IL-8, and IL-12 concentrations between the study groups. The higher levels of IL-10 and the attenuating of WBC decline during chemotherapy may constitute preliminary evidence of the beneficial effects of WGJ on immune parameters, when given as a supplement to standard care. In light of these preliminary results, WGJ supports immunological parameters during adjuvant chemotherapy. Nevertheless, future studies are needed in order to translate those results to clinical recommendations for cancer survivors.
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Affiliation(s)
- Adva Avisar
- The Graduate Studies Authority, University of Haifa, Haifa 31000, Israel;
| | - Miri Cohen
- School of Social Work, University of Haifa, Haifa 31000, Israel;
| | - Rina Katz
- Clinical Immunology and Tissue Typing Lab, Rambam Medical Center, Haifa 31000, Israel;
| | | | - Anat Aharon
- Hematology and Bone Marrow Transplantation, Sourasky Medical Center, Tel Aviv 6423906, Israel;
| | - Gil Bar-Sela
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 31000, Israel
- Cancer Center, Emek Medical Center, 21 Yitzhak Rabin Blvd., Afula 1834111, Israel
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Nakash O, Granek L, Cohen M, Bar-Sela G, Geffen D, Ben David M. Does Assessment Method Matter in Detecting Mental Health Distress among Ashkenazi and Mizrahi Israeli Women with Breast Cancer? Health Soc Work 2020; 45:101-109. [PMID: 32390055 DOI: 10.1093/hsw/hlaa004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 04/05/2019] [Accepted: 05/14/2019] [Indexed: 06/11/2023]
Abstract
Authors examined differences in assessment method (structured diagnostic interview versus self-report questionnaire) between ethnic groups in the prevalence of mood and anxiety disorders among women with breast cancer. A convenience sample of 88 Mizrahi (Jews of Middle Eastern/North African descent, n = 42) and Ashkenazi (Jews of European/American descent, n = 46) women with breast cancer from oncology units in three health centers across Israel participated in the study. Participants were within eight months of diagnosis. Participants completed the Hospital Anxiety and Depression Scale (HADS) and a structured diagnostic interview, the Mini-International Neuropsychiatric Interview (MINI). Approximately one-third (31.8 percent, n = 28) of participants were diagnosed with at least one mood or anxiety disorder based on the MINI. Significantly more Mizrahi participants (42.9 percent) were diagnosed with at least one mood or anxiety disorder, compared with their Ashkenazi counterparts (21.7 percent). Mean score on HADS was below the optimal cutoff score (≥13) among all participants, with no significant difference in mean score for emotional distress based on HADS between the two ethnic groups. The findings highlight the role of measurement variance in assessing mental health distress among women with breast cancer in general and among ethnic and racial minorities in particular.
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Affiliation(s)
- Ora Nakash
- School of Social Work, Smith College, Northampton, MA 01063
| | - Leeat Granek
- School of Health Policy and Management, Faculty of Health, York University, Toronto
| | - Michal Cohen
- Baruch Ivcher School of Psychology, Interdisciplinary Center, Herzliya, Israel
| | - Gil Bar-Sela
- Department of Oncology, Rambam Health Care Campus, Haifa, Israel
| | - David Geffen
- Department of Oncology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel
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Zer A, Icht O, Joseph L, Avram D, Jacobi O, Fenig E, Kurman N, Peretz I, Shamai S, Merimsky O, Ben-Ami E, Shapira R, Schwarzbach AE, Bernstine H, Weitzen R, Vornicova O, Bar-Sela G, Stemmer SM, Lotem M. A phase II single-arm study of nivolumab and ipilimumab (Nivo/Ipi) in previously treated classical Kaposi sarcoma (CKS). J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.11518] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
11518 Background: CKS is a mesenchymal neoplasm associated with HHV8 infection. Though recombinant INFa is approved for treatment of AIDS-related KS, data is limited regarding the role of immune modulation in CKS therapy. Based on favorable responses in viral-induced cancers, we hypothesized that CTLA-4 and PD-1 blockade can induce tumor regression in CKS. We present pre-planned interim analysis of a phase II study of Nivo/Ipi in previously treated progressive CKS. Methods: CKS pts with progressive disease after > 1 line of systemic therapy and measurable disease received nivolumab 240mg d1,15,28 and ipilimumab 1mg/kg d1 q42 days until progression or toxicity. The primary endpoint was overall response rate (ORR) evaluated clinically, radiologically (RECIST) and metabolically (FDG-PET). Secondary endpoints include 6-months progression free survival rate (PFS) and safety. Exploratory endpoints included PD-L1/MMR by IHC, DNAseq (596 genes)/RNAseq (whole transcriptome) of tumor and matched blood specimens to explore CKS genomic traits and IO correlates: TMB and MSI status, MMR and PD-L1 protein expression, and immune gene transcript expression (PD-1, PD-L1, CTLA-4, and others) (Tempus Labs, Chicago, IL, USA). Results: Fifteen patients were enrolled and evaluable (Apr18-Jan20). Median age 72.5 (61-81), all male. At a median FU of 15.7 mo ORR as per RECIST was 66% (9 pts PR, 1 pt CR, 2 pts SD, 3 pts NE). Clinical ORR was 87% and metabolic ORR was 60%. Median PFS was not reached, 6mo PFS rate was 85% and 1y PFS rate was 75%. The safety profile was as expected with all pts experiencing G1 toxicity, 3 pts with G2 toxicity (1 hepatic, 2 asymptomatic lipase increase) and 2 pts with G3 toxicity (1 colitis, 1 asymptomatic lipase increase). One SAE was reported (TIA considered not related to therapy) and treatment was discontinued in 3 pts. Correlative results are available for 8 pts showing a trend for copy number loss in genes with tumor-suppressive activity (FOXA1, ELF3), no PDL1 expression, low TMB, microsatellite stability, but marked overexpression of CTLA-4, PD-1, PDL-1, CD40, OX40 and LAG3 RNA immune transcripts. Conclusions: The interim analysis of this prospective phase II study of nivolumab and low-dose ipilimumab demonstrates promising activity in progressive CKS, with 66% ORR and a 6mo PFS rate of 85%. Toxicity profile is as expected in this class of drugs. Correlative studies are preliminary, but warrant further investigation into genomic traits and immune gene expression profiles. Clinical trial information: NCT03219671. Clinical trial information: NCT03219671 .
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Affiliation(s)
- Alona Zer
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Oded Icht
- Thoracic Cancer Unit, Davidoff Cancer Institute, Rabin Medical Center, Affiliated to the Sackler Faculty of Medicine, Petah Tikva, Israel
| | | | - Dana Avram
- Rabin Medical Center, Petah Tikva, Israel
| | | | - Eyal Fenig
- Rabin Medical Center, Petah Tikva, Israel
| | - Noga Kurman
- Davidoff Cancer Center, Rabin Medical Center-Beilinson Campus, Petah Tikva, Israel
| | - Idit Peretz
- Davidoff Center, Rabin Medical Center, Petah Tikva, Israel
| | - Sivan Shamai
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ofer Merimsky
- Tel Aviv Medical Center and Sackler School of Medicine, Tel Aviv, Israel
| | | | - Roni Shapira
- Chaim Sheba Medical Center, Tel Hashomer, Israel
| | | | | | | | | | | | - Salomon M. Stemmer
- Davidoff Cancer Center, Rabin Medical Center-Beilinson Hospital, Petah Tikva, Israel
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Bar-Sela G, Samih Y, Yerushalmi R, Leviov M, Efrat Ben-Baruch N, Kuchuk I, Tokar M, Peretz-Yablonski T, Sonnenblick A, Soussan-Gutman L, Bareket-Samish A, Fried G, Paluch-Shimon S, Kaufman B, Hammerman A, Liebermann N, Stemmer SM. Ethnicity, recurrence score distribution, and clinical outcomes in ER + HER2-negative breast cancer patients in Israel: A registry analysis. Breast J 2020; 26:2096-2098. [PMID: 32419268 DOI: 10.1111/tbj.13870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 04/14/2020] [Accepted: 04/15/2020] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - Rinat Yerushalmi
- Davidoff Center, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | | | | | - Margarita Tokar
- Soroka University Medical Center and The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | | | - Amir Sonnenblick
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Tel-Aviv Sourasky Medical center, Tel Aviv, Israel
| | | | | | | | | | - Bella Kaufman
- The Chaim Sheba Medical Center Tel Hashomer, Ramat Gan, Israel
| | - Ariel Hammerman
- Community Division, Clalit Health Services, Tel Aviv, Israel
| | | | - Salomon M Stemmer
- Davidoff Center, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Bar-Sela G, Zalman D, Semenysty V, Ballan E. The Effects of Dosage-Controlled Cannabis Capsules on Cancer-Related Cachexia and Anorexia Syndrome in Advanced Cancer Patients: Pilot Study. Integr Cancer Ther 2020; 18:1534735419881498. [PMID: 31595793 PMCID: PMC6785913 DOI: 10.1177/1534735419881498] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background: Cancer-related cachexia and anorexia syndrome (CACS) is a common phenomenon in cancer patients. Cannabis has been suggested to stimulate appetite but research on this issue has yielded mixed results. The current study aimed to evaluate the effect of dosage-controlled cannabis capsules on CACS in advanced cancer patients. Methods: The cannabis capsules used in this study contained two fractions of oil-based compounds. The planned treatment was 2 × 10 mg per 24 hours for six months of tetrahydrocannabinol (THC) 9.5 mg and cannabidiol (CBD) 0.5 mg. If patients suffered from side effects, dosage was reduced to 5 mg × 2 per day (THC 4.75 mg, CBD 0.25 mg). Participants were weighed on every physician visit. The primary objective of the study was a weight gain of ≥10% from baseline. Results: Of 24 patients who signed the consent form, 17 started the cannabis capsules treatment, but only 11 received the capsules for more than two weeks. Three of six patients who completed the study period met the primary end-point. The remaining three patients had stable weights. In quality of life quaternaries, patients reported less appetite loss after the cannabis treatment (p=0.05). Tumor necrosis factor-α (TNF-α) levels decreased after the cannabis treatment but without statistical significance. According to patients’ self-reports, improvement in appetite and mood as well as a reduction in pain and fatigue was demonstrated. Conclusions: Despite various limitations, this preliminary study demonstrated a weight increase of ≥10% in 3/17 (17.6%) patients with doses of 5mgx1 or 5mgx2 capsules daily, without significant side effects. The results justify a larger study with dosage-controlled cannabis capsules in CACS.
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Affiliation(s)
- Gil Bar-Sela
- Emek Medical Center, Afula, Israel.,Technion-Israel Institute of Technology, Haifa, Israel
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