Cardio-Oncology: The Need of the Hour Subspeciality

There have been considerable advancements in cancer therapy in recent years. However, adverse effects often defeat the benefits, especially on the cardiovascular system. The effects of chemotherapeutic agents on the cardiovascular system can be directly on the heart by altering the coagulability state or by altering the hemodynamic system. Some drugs like Sunitinib and Bevacizumab show Heart Failure which is chemotherapy-induced. Other agents are notorious for showing QT prolongation like Vandetanib. Similarly, other agents with demonstrated cardiotoxicity would be molecular-targeted drugs (Trastuzumab and Pertuzumab) and cytostatic agents (Anthracycline antibiotics, Cyclophosphamide and 5-FU). These effects may present early or late, during or after the treatment. Most of the research has focused on the management and monitoring of patients for cancer who are under treatment, for example new biomarkers in the field of proteomics have been discovered for the diagnosis, treatment, and monitoring of patients. While the upgrades have been successful in reducing mortalities, with the advent of better treatment outcomes, the several adverse effects on the cardiac system cannot be dismissed. For instance, damage to the cardiomyocytes is most frequently associated with the treatment. The damage can further expedite LV failure, valvular dysfunction, conduction abnormalities, etc. Hence, a better management plan for patients with cancer would be one that not only caters to primary cancer treatment but also incorporates ventricular systolic function evaluation using echocardiography, electrocardiography, and cardiac biomarkers for the well-being of patients. Our article focuses on introducing an ideal cardio-oncology team along with the components required for setting up the team. This needs a multidisciplinary approach to reduce patients’ cardiovascular morbidity, during and after the interventions. With the growing population of patients undergoing cancer therapy, the risk of developing cardiovascular problems has further escalated. Hence, development of a cardio-oncology multidisciplinary team would be of utmost importance to not only improve patient care but also to improve quality of life.

Personalized medicine:Clinical oncology on molecular view of treatment

Cancer,the second leading global cause of death,impacts both physically and emotionally.Conventional treatments such as surgeries,chemotherapy,and radiotherapy have adverse effects,driving the need for more precise approaches.Precision medicine enables more targeted treatments.Genetic mapping,alongside other molecular biology approaches,identifies specific genes,contributing to accurate prognoses.The review addresses,in clinical use,a molecular perspective on treatment.Biomarkers like alpha-fetoprotein,beta-human chorionic gonadotropin,5-hydroxyindoleacetic acid,programmed death-1,and cytotoxic T lymphocyte-associated protein 4 are explored,providing valuable information.Bioinformatics,with an emphasis on artificial intelligence,revolutionizes the analysis of biological data,offering more accurate diagnoses.Techniques like liquid biopsy are emphasized for early detection.Precision medicine guides therapeutic strategies based on the molecular characteristics of the tumor,as evidenced in the molecular subtypes of breast cancer.Classifications allow personalized treatments,highlighting the role of trastuzumab and endocrine therapies.Despite the benefits,challenges persist,including high costs,tumor heterogeneity,and ethical issues.Overcoming obstacles requires collaboration,ensuring that advances in molecular biology translate into accessible benefits for all.

Chronic hepatitis B and occult infection in chemotherapy patients-evaluation in oncology and hemato-oncology settings:The CHOICE study

BACKGROUND Reactivation of hepatitis B virus(HBV)infection is a well-known risk that can occur spontaneously or following immunosuppressive therapies,including cancer chemotherapy.HBV reactivation can cause significant morbidity and even mortality,which are preventable if at-risk individuals are identified through screening and started on antiviral prophylaxis.AIM To determine the prevalence of chronic HBV(CHB)and occult HBV infection(OBI)among oncology and hematology-oncology patients undergoing chemo-therapy.METHODS In this observational study,the prevalence of CHB and OBI was assessed among patients receiving chemotherapy.Serological markers of HBV infection[hepatitis B surface antigen(HBsAg)/anti-hepatitis B core antigen(HBc)]were evaluated for all patients.HBV DNA levels were assessed in those who tested negative for HBsAg but positive for total anti-HBc.RESULTS The prevalence of CHB in the study cohort was determined to be 2.3%[95%confidence interval(95%CI):1.0-4.2].Additionally,the prevalence of OBI among the study participants was found to be 0.8%(95%CI:0.2-2.3).CONCLUSION The findings of this study highlight the importance of screening for hepatitis B infection in oncology and hematology-oncology patients undergoing chemotherapy.Identifying individuals with CHB and OBI is crucial for implementing appropriate antiviral prophylaxis to prevent the reactivation of HBV infection,which can lead to increased morbidity and mortality.

Analysis of the Necessity and Modalities of Imparting Death Education to Medical Students Undergoing Training in Oncology Departments

Patients with advanced-stage tumors may experience various psychological problems that can have a significant impact on the effectiveness of cancer treatment and the quality of their survival.Therefore,it is crucial for oncologists to prioritize addressing the psychological issues that patients encounter throughout the diagnosis and treatment process.As future frontline healthcare professionals,oncology medical students should receive education on end-of-life care early on in their training.This will enable them to develop a profound appreciation for the value of life,deliver improved medical services,and contribute to the humanization of medicine.Furthermore,they will be able to provide terminal patients and their families with effective professional guidance,assisting patients in finding peaceful endings with minimal pain and helping families come to terms with the inevitable realities they face.Moreover,this education can effectively enhance their sense of responsibility toward life and cultivate a positive and optimistic attitude toward their own lives.

Community-Based Oncology Nursing:Current Status and Prospects-A Secondary Publication

Objective:Currently,it is difficult to determine whether a comprehensive and systematic community-based cancer care project is properly implemented.The purpose of this article is to present the current status and prospects of community-based oncology nursing by reviewing related literature.Methods:A new cancer care model was established through the analysis of existing models and a literature review of community-based cancer prevention,cancer screening,cancer survivor care,and cancer patient hospice care.Results:The Comprehensive Cancer Care Model(CCCM)was esrablished.The CCCM organizes the stages of cancer treatment and the cancer journey on the horizontal axis.On the vertical axis,public health centers,oncology hospitals,cancer convalescent hospitals,primary care physicians,and prayer centers were involved.The levels of participation of human resources among institutions and the degree of interconnection between organizations was observed.Conclusion:It is expected that CCCM will be used for holistic,sustainable,and cost-effective cancer management.In community-based oncology nursing,the team of health promotion nurses in public health centers is in charge of population-based cancer prevention and early detection programs,while the visiting health management team of nurses is in charge of individual-based cancer survivor and hospice programs.

A Bibliometric Analysis of Global Research Trends of Exercise in Oncology During the Past Three Decades

Recently, studies have found that exercise can promote recovery in cancer patients. Based on bibliometric analysis, this paper discusses the trends and hot spots of exercise oncology research in the past 30 years. The Science Citation Index Expanded of the Web of Science Core Collection (WoSCC) was searched to obtain information on publications and records published between 1993 to 2023.VOSviewer and CiteSpace were used to conduct bibliometric and visual analyanalysis on the overall distribution of keywords and highly cited papers, and a total of 1775 articles were retrieved. Harvard University was the institution with the highest number of publications and Fearon ranked first in 2013 with a total of 605 citations.

Survey and Analysis of Postoperative Quality of Life in Gynaecological Oncology Patients

Goal:To investigate the current status of quality of life of postoperative patients with gynaecological tumours,and to analyse the relevant factors affecting the quality of life of postoperative patients with gynaecological tumours.Method:One hundred and fifty-three postoperative gynecological oncology patients who attended the gynaecology and oncology departments of three tertiary hospitals in Henan Province from June 2023 to March 2024 were investigated by convenience sampling method.The patients’postoperative survival quality was investigated through the General Information Survey Scale and Quality of Life Score Scale.Results:The quality of life measurement scale score of postoperative gynaecological oncology patients in this study was(121.27±10.87),in which there was a difference in the quality of life of postoperative gynaecological oncology patients of different age,education level,marital status,and per capita monthly income of the family,p<0.05.Conclude:The quality of life level of postoperative gynaecological oncology patients is generally good,and age,literacy,marital status,and per capita monthly family income are important factors in the postoperative quality of life of gynaecological oncology patients.Healthcare professionals should focus on patients with older age,lower education level,unstable marital status,and poor economic status,and provide personalised targeted interventions to improve their quality of life.

Exercise and oncology:The role of physical activity in disease prevention and health promotion

The field of exercise-oncology has evolved significantly over the past 30 years.Numerous studies have examined the role of structured exercise interventions—often incorporating aerobic or resistance training at moderate-to-vigorous intensities,sometimes in conjunction with multi-modal strategies—for individuals living with and beyond cancer.

The Psychological Experience of the Nursing Staff of the Medical Oncology Department in Cameroon: Case of the YaoundéGeneral Hospital

Background: The world of cancer care is an emotional place, given the severity of the disease being treated, the heavy workload, the suffering of patients, and the high number of deaths. The nursing staff who work there may be exposed to constant stress from these factors. This study aimed to explore the psychological experience of the nursing staff of the Medical Oncology Department of the Yaoundé General Hospital. Methods: We carried out a cross-sectional study, in June 2017, involving the nursing staff of the Medical Oncology Department of the Yaoundé General Hospital. Results: Sixteen out of 18 nurses were interviewed. All had worked in at least one other department prior to Oncology. The number of years of experience in Oncology ranged from less than one year to 13 years. The choice of the Oncology department was involuntary for 100% of the staff;of these, 62% had intentions of changing departments. Twenty-five percent had applied for a change of department, which was unsuccessful. Stress was expressed by 94% of the staff;93% thought that there was a solution to the stress experienced on a daily basis in the Oncology department. The main solutions proposed to manage this stress were: support for the staff, provision of work materials, and staff training. Conclusion: The nursing staff of the Medical Oncology Department of the Yaoundé General Hospital experiences a high level of stress and are in need of solutions.

Clinical infections in neurosurgical oncology:An overview

Central nervous system(CNS)infections are urgent conditions with high morbidity and mortality.Bacteria,viruses,parasites or fungi can cause them.Intracranial infections after craniotomies are an important complication of treatment,especially in oncological patients that are already immunologically compromised due to the disease and treatment.The consequence of CNS infections in oncological patients includes longer treatment with antibiotics,additional surgical procedures,higher treatment costs and poorer treatment outcomes.Additionally,the management of primary pathology may be prolonged or postponed as a result of the active infection.By introducing new and improved protocols,tightening controls on their implementation,constantly educating the entire team involved in patient treatment and educating both patients and relatives,the incidence of infections can be reduced effectively.

Nursing Care in Patient with Advanced Cancer: The Experience of the Adult Oncology Unit of Lomé

Background: Cancer patients suffer physical, psychological, spiritual, and social pains, especially in the advanced stage. Nurses spend more time with patients than any other healthcare team member. This study aimed to assess nurses’ behavior and care experiences in patients with advanced cancer and explore patients’ perceptions of nursing care. Methods: A cross-sectional study was conducted with eight nurses and thirty patients with advanced cancer hospitalized in the oncology unit at Sylvanus Olympio Teaching Hospital of Lomé from July to August 2020. Results: The mean age of nurses was 34.3 years ranging from 23 to 48 years. There were five men (62.5%) and three women (37.5%). The mean duration of working in oncology nursing of all was less than two years. Only one nurse has training in palliative care. Stress (100%), sadness (100%), and fear (50%) were the most frequently expressed feeling of nurses. The frequently expressed difficulties were the lack of training in palliative care (87.5%), insufficiency of nursing staff (75%), and helplessness in front of the patient’s distress (75%). Among the thirty patients, were 22 women (72.7%) and 8 men (27.3%). The needs expressed by the patients were psychological support (n = 11;36.7%), pain relief (n = 10;33.3%), and moral support (n = 9;30%). Most of the patients (73.3%) affirmed that nurses did not inform them well about their disease. Three (10%) were very satisfied with the care provided, 23 patients (76.7%) were satisfied and 4 (13.3%) were unsatisfied. Conclusion: This study revealed that nursing care in Togolese patients with cancer faces many difficulties and there is a need for providing specialized oncology nursing.

Analysis of Local Diagnostic Reference Levels for Pediatric Patients Undergoing 18F-FDG PET/CT Imaging for Oncology

Background: The PET/CT imaging studies have two doses components the dose from the PET radiopharmaceutical and the other from the low dose CT used for PET images attenuation correction. We have one PET/CT scanner at our institution a Philips Time of Flight scanner. Our local patient’s radiation protection rules requires continuous assessment of radiation doses delivered to our patients. Purposes: The objectives of this study are to develop a weight- based facility DRLs for paediatric F-18-FDG PET-CT imaging for oncology in a large tertiary hospital and to determine whether the calculated DRLs compares with internationally published DRLs. Materials & Methods: Radiation dose data and patient demographics of two-hundreds and sixteen paediatric PET-CT oncology patients imaging procedures from one large tertiary hospital were selected and analysed in order to establish a facility paediatric DRLs. Statistical analysis was performed. Results: The PET dose reference levels ranged between [62 - 525] MBq of injected activity for a range of pediatric age groups. The CTDIvol values were between 3.5 and 16.5 mGy for all age groups. Comparison with current EANM and SNMMI recommendations of patient’s dose are discussed. Conclusion: Our pediatric PET/CT reference levels are higher than the ones reported internationally with notable variations. .

Application of evidence-based medicine methods in integrative oncology research

To present the advances of evidence-based medicine and clinical research methodology in integrative oncology,we conducted a literature review of real-world studies of traditional Chinese medicine(TCM)in cancer care and summarized the available evidence.Pragmatic randomized controlled trials(pRCTs)and clinical registry studies are becoming more popular as they could compensate for the limitations of RCTs.Many RCTs of TCM for cancer treatment as well as systematic reviews have been published.The most investigated therapies are based on acupuncture,Chinese herbal compounds,and Chinese patent medicines.Acupuncture has a significant advantage in relieving cancer-related symptoms.Published studies focus more on improving clinical symptoms and laboratory indicators.However,the patient's quality of life deserves more attention.

Self-adhesive pads in defi brillation or cardioversion: risks due to unfamiliarity and recommendations

During cardiopulmonary resuscitation(CPR),defibrillation,or cardioversion,the use of self-adhesive pads instead of conventional paddles has gradually become common.In particular,it was recommended during the COVID-19 pandemic,as it allows defibrillation or cardioversion to be performed without close contact between the rescuer and patient.[1,2]Self-adhesive pads can minimize the downtime of chest compressions before and after defibrillation and protect the patient from electric arc formation,skin burns,and fi re.Once the pads are attached,electrocardiographic rhythm analysis,defibrillation,synchronous cardioversion,and cardiovascular support are all possible.Unlike paddles,self-adhesive pads can save time because the application of conductive jelly,repeated positioning,and application of 10-12 kg of pressure on the chest are not needed.The European Resuscitation Council(ERC)Guidelines 2021 state that the use of self-adhesive pads is recommended in advanced cardiovascular life support(ACLS).[3]Nevertheless,some medical staff still tend to prefer the use of conventional paddles instead of self-adhesive pads in hospitals.

Oncologic outcomes with and without amniotic membranes in robotic-assisted radical prostatectomy:A propensity score matched analysis

Objective:Placement of human placenta derived grafts during robotic-assisted radical prostatectomy(RARP)hastens the return of continence and potency.The long-term impact on the oncologic outcomes remains to be investigated.Our objective was to determine the oncologic outcomes of patients with dehydrated human amnion chorion membrane(dHACM)at RARP compared to a matched cohort.Methods:In a referral centre,from August 2013 to October 2019,599 patients used dHACM in bilateral nerve-sparing RARP.We excluded patients with less than 12 months follow-up,simple prostatectomy,and unilateral nerve-sparing.Patients with dHACM(amnio group)were 529,and were propensity score matched 1:1 to 2465 patients without dHACM(non-amnio group)and a minimum follow-up of 36 months.At the time of RARP,dHACM was placed around the neurovascular bundle in the amnio group.Continuous and categorical variables in matched groups was tested by two-sample Kolmogorov-Smirnov test and Fisher's exact test respectively.Outcomes measured were biochemical recurrence(BCR),adjuvant and salvage therapy rates.Results:Propensity score matching resulted in two groups of 444 patients.Cumulative incidence functions for BCR did not show a difference between the groups(p=0.3).Patients in the non-amnio group required salvage therapy more frequently than the amnio group,particularly after partial nerve-sparing RARP(6.3%vs.2.3%,p=0.001).Limitations are the absence of prospective randomization.Conclusion:The data suggest that using dHACM does not have a negative impact on BCR in patients.Outcomes of cancer specific and overall survival will require follow-up study to increase our understanding of these grafts’impact on prostate cancer biology.

Next Generation Sequencing in Oncological Diagnostics: Hype or Hope?

The understanding of how genetic and epigenetic factors influence tumorigenesis, progression and invasion, is vastly growing since new technologies allow the analysis of the functional genome namely the exome, the transcriptome and the epigenome, besides enabling genome-wide assessment of genetic variations. With the advent of new drugs that are indicated tissue agnostic, depending on certain mutations, there is a growing demand for fast and cost-effective genetic diagnosis. The method in focus that already became an indispensable tool in viral diagnosis is next-generation sequencing (NGS). This approach allows sequencing of literally every DNA molecule in the sample and can either be used to assess numerous genetic markers of one patient at a time, or to assess fewer markers of many patients in parallel, which reduces costs. We submitted 23 samples of different tumor entities to four diagnostic companies with different analysis profiles. The results as disclosed and discussed in this report indicate that so far, the main application of NGS is rather in cancer research than in diagnosis, as none of the reports had a real impact on the therapeutic scheme. We are perfectly aware that such a small cohort cannot be generalized, but considering the costs vs. benefits, NGS should be engaged upon a very stringent evaluation only. However, in cases where obtaining a tissue biopsy is impossible or unfavorable, analysis of liquid biopsy by NGS provides a vital alternative.

Insights into cardio-oncology:Polypharmacology of quinazoline-based α1-adrenoceptor antagonists

New uses of cardiovascular drugs with proven experience are emerging,including for treating cancer.Quinazoline is a compound made up of two fused six member simple aromatic rings,benzene and pyrimidine rings,with several biological effects.Cardiologists first used quinazoline-based α1-adrenoceptor antagonists prazosin,doxazosin,and terazosin; currently available data support their use as safe,well tolerated,and effective add-on therapy in uncontrolled hypertension with additional favourable metabolic effects.Recent findings highlight the anticancer effects of quinazoline-based α1-adrenoceptor antagonists,indicating that they may have a significant role in uncontrolled hypertensive cancer patients without signs of ischemia.

Oncological features and prognosis of colorectal cancer in human immunodeficiency virus-positive patients: A retrospective study

BACKGROUND Due to the prolonged life expectancy and increased risk of colorectal cancer(CRC)among patients with human immunodeficiency virus(HIV)infection,the prognosis and pathological features of CRC in HIV-positive patients require examination.AIM To compare the differences in oncological features,surgical safety,and prognosis between patients with and without HIV infection who have CRC at the same tumor stage and site.METHODS In this retrospective study,we collected data from HIV-positive and-negative patients who underwent radical resection for CRC.Using random stratified sampling,24 HIV-positive and 363 HIV-negative patients with colorectal adenocarcinoma after radical resection were selected.Using propensity score matching,we selected 72 patients,matched 1:2(HIV-positive:negative=24:48).Differences in basic characteristics,HIV acquisition,perioperative serological indicators,surgical safety,oncological features,and long-term prognosis were compared between the two groups.RESULTS Fewer patients with HIV infection underwent chemotherapy compared to patients without.HIV-positive patients had fewer preoperative and postoperative leukocytes,fewer preoperative lymphocytes,lower carcinoembryonic antigen levels,more intraoperative blood loss,more metastatic lymph nodes,higher node stage,higher tumor node metastasis stage,shorter overall survival,and shorter progression-free survival compared to patients who were HIV-negative.CONCLUSION Compared with CRC patients who are HIV-negative,patients with HIV infection have more metastatic lymph nodes and worse long-term survival after surgery.Standard treatment options for HIV-positive patients with CRC should be explored.

The promises and challenges of patient-derived tumor organoids in drug development and precision oncology

In the era of precision medicine,cancer researchers and oncologists are eagerly searching for more realistic,cost effective,and timely tumor models to aid drug development and precision oncology.Tumor models that can faithfully recapitulate the histological and molecular characteristics of various human tumors will be extremely valuable in increasing the successful rate of oncology drug development and discovering the most efficacious treatment regimen for cancer patients.Two‐dimensional(2D)cultured cancer cell lines,genetically engineered mouse tumor(GEMT)models,and patient‐derived tumor xenograft(PDTX)models have been widely used to investigate the biology of various types of cancers and test the efficacy of oncology drug candidates.However,due to either the failure to faithfully recapitulate the complexity of patient tumors in the case of 2D cultured cancer cells,or high cost and untimely for drug screening and testing in the case of GEMT and PDTX,new tumor models are urgently needed.The recently developed patient‐derived tumor organoids(PDTO)offer great potentials in uncovering novel biology of cancer development,accelerating the discovery of oncology drugs,and individualizing the treatment of cancers.In this review,we will summarize the recent progress in utilizing PDTO for oncology drug discovery.In addition,we will discuss the potentials and limitations of the current PDTO tumor models.

Watson for Oncology在乳腺癌治疗中的应用与思考

目的:本研究旨在分析Watson for Oncology在中国乳腺癌辅助诊治中的应用与医生MDT诊治的一致性,以及差异的可能原因。方法:于2017年1月至2018年1月收治早期乳腺癌患者92例和晚期乳腺癌患者40例。由乳腺癌MDT团队确定的治疗方案为医院方案;根据患者的基本情况,采用Watson for Oncology 17.10版给予的治疗方案为Watson方案,评估两者方案的一致性并解析差异的可能原因。结果:医院方案与Watson方案一致共计101例,占76.51%。其中早期和晚期乳腺癌方案一致分别为73例和28例,分别占79.35%和70.00%。医院方案在Watson方案中的绿色推荐方案49例,占37.12%;橙色考虑方案52例,占39.39%;粉色不推荐方案26例,占19.70%;医院方案另有5例方案不在Watson方案中,占3.79%。Watson方案与医院方案在组织学Ⅲ期的患者中一致率最高,达到95.00%,三阴性乳腺癌无论早期还是晚期都表现出最高的一致率,分别为86.67%和100%。早期Luminal A和晚期HER2阳性型的医院方案在Watson绿色推荐方案占比较低,仅27.27%和0%。早期乳腺癌差异原因包括中低危复发风险的11例患者应用紫杉醇联合环磷酰胺(TC方案)和2例患者应用表柔比星联合环磷酰胺(EC方案),而Watson方案推荐为阿柔比星+环磷酰胺序贯紫杉醇(AC-T方案)和CMF方案(国内很少应用的方案)。HER2阳性不一致的是Watson推荐CMF+曲妥珠单抗方案,而医院方案考虑心脏毒性小而治疗疗效与AC-TH相似的TCb H方案。晚期不一致原因是CDK4/6抑制剂未在国内上市应用等。结论:医院方案和Watson方案在中国乳腺癌患者的辅助治疗和晚期一线治疗中一致性较好,但组织学分期和分子分型影响医院方案与Watson方案的一致率,需要实现本地化优化辅助治疗方案。