Kamile Silay

A laboratory prognostic index model for patients with advanced non-small cell lung cancer.

Purpose We aimed to establish a laboratory prognostic index (LPI) in advanced non-small cell lung cancer (NSCLC) patients based on hematologic and biochemical parameters and to analyze the predictive value of LPI on NSCLC survival. Patients and Methods The study retrospectively reviewed 462 patients with advanced NSCLC diagnosed between 2000 and 2010 in a single institution. We developed an LPI that included serum levels of white blood cells (WBC), lactate dehydrogenase (LDH), albumin, calcium, and alkaline phosphatase (ALP), based on the results of a Cox regression analysis. The patients were classified into 3 LPI groups as follows: LPI 0: normal; LPI 1: one abnormal laboratory finding; and LPI 2: at least 2 abnormal laboratory findings. Results The median follow up period was 44 months; the median overall survival (OS) and median progression-free survival (PFS) were 11 and 6 months, respectively. A multivariate analysis revealed that the following could be used as independent prognostic factors: an Eastern Cooperative Oncology Group performance status score (ECOG PS) ≥2, a high LDH level, serum albumin <3 g/dL, serum calcium>10.5 g/dL, number of metastases>2, presence of liver metastases, malignant pleural effusion, or receiving chemotherapy ≥4 cycles. The 1-year OS rates according to LPI 0, LPI 1, and LPI 2 were 54%, 34%, and 17% (p<0.001), respectively and 6-month PFS rates were 44%, 27%, and 15% (p<0.001), respectively. The LPI was a significant predictor for OS (Hazard Ratio (HR): 1.41; 1.05–1.88, p<0.001) and PFS (HR: 1.48; 1.14–1.93, p<0.001). Conclusion An LPI is an inexpensive, easily accessible and independent prognostic index for advanced NSCLC and may be helpful in making individualized treatment plans and predicting survival rates when combined with clinical parameters.

Medication Errors in Chemotherapy Preparation and Administration: a Survey Conducted among Oncology Nurses in Turkey

BACKGROUND Medication errors in oncology may cause severe clinical problems due to low therapeutic indices and high toxicity of chemotherapeutic agents. We aimed to investigate unintentional medication errors and underlying factors during chemotherapy preparation and administration based on a systematic survey conducted to reflect oncology nurses experience. MATERIALS AND METHODS This study was conducted in 18 adult chemotherapy units with volunteer participation of 206 nurses. A survey developed by primary investigators and medication errors (MAEs) defined preventable errors during prescription of medication, ordering, preparation or administration. The survey consisted of 4 parts: demographic features of nurses; workload of chemotherapy units; errors and their estimated monthly number during chemotherapy preparation and administration; and evaluation of the possible factors responsible from ME. The survey was conducted by face to face interview and data analyses were performed with descriptive statistics. Chi-square or Fisher exact tests were used for a comparative analysis of categorical data. RESULTS Some 83.4% of the 210 nurses reported one or more than one error during chemotherapy preparation and administration. Prescribing or ordering wrong doses by physicians (65.7%) and noncompliance with administration sequences during chemotherapy administration (50.5%) were the most common errors. The most common estimated average monthly error was not following the administration sequence of the chemotherapeutic agents (4.1 times/month, range 1-20). The most important underlying reasons for medication errors were heavy workload (49.7%) and insufficient number of staff (36.5%). CONCLUSIONS Our findings suggest that the probability of medication error is very high during chemotherapy preparation and administration, the most common involving prescribing and ordering errors. Further studies must address the strategies to minimize medication error in chemotherapy receiving patients, determine sufficient protective measures and establishing multistep control mechanisms.

Lung Cancer in Women, a Different Disease: Survival Differences by Sex in Turkey

PURPOSE In this study, we aimed to evaluate the effects of sex-based non-small cell lung cancer (NSCLC) varieties on survival rates. MATERIALS AND METHODS A retrospective study was performed in patients with NSCLC who were diagnosed by histological methods between the years 2000 and 2010. A chi-square test was used to compare variables. Overall survival (OS) was estimated by the Kaplan-Meier method. RESULTS Of the 844 patients, 117 (13.9%) were women and 727 (86.1%) were men. Adenocarcinoma was more common in women than in men (p<0.0001). There were more women non-smokers than men (p<0.0001). There was no statistically significant difference in ECOG PS, weight loss>10%, stage, LDH, albumin and treatment between women and men. Women younger than 65 years (17.0 vs 12.0 months; p=0.03), who had adenocarcinoma histology (15.0 vs 10.0 months; p=0.006) and who had a hemoglobin level≥12 g/dL (18.0 vs 12.0 months; p=0.01) were found to have a better median OS rate than men. Median OS rates were found to be 13.0 months in females and 12.0 months in males (p=0.14). Among metastatic patients, the median OS was 11.0 months in females and 8.0 months in males (p=0.005). Among stage IIIB and stage IV patients who had first line platinum-based chemotherapy, the median OS was 17.0 months in women and 11.0 months in men (p=0.002). The response rate of chemotherapy was higher in women than in men (p=0.03). CONCLUSIONS In our study, we found that survival duration is longer and chemotherapy response is better in women with NSCLC who do not have anemia or comorbidities and who are mostly non-smokers with adenocarcinomas. Further studies regarding the causes of these differences may provide clarity on this subject.

1310PA LABORATORY PROGNOSTIC INDEX MODEL FOR PATIENTS WITH ADVANCED NON-SMALL CELL LUNG CANCER

ABSTRACT Aim: We aimed to establish a laboratory prognostic index (LPI) in patients with advanced non- small cell lung cancer (NSLCL) based on clinical and histological characteristics, hematologic and biochemical basal parameters and their effects on survival. The predictive value of LPI on NSCLC survival was evaluated. Methods: The study retrospectively reviewed 462 patients with advanced NSCLC diagnosed between the years of 2000-2009 in a single institution. Twenty one clinical, hematological and biochemical factors were evaluated with univariate and multivariate analysis. A laboratory prognostic index (LPI) was developed based on WBC, LDH, ALB, CA and ALP levels with univariate and multivariate stepwise Cox regression analyses. LPI was classified into 3 groups as LPI 0: normal laboratory findings, LPI 1: one abnormal laboratory finding, and LPI 2: at least 2 abnormal laboratory findings. Results: Among 462 patients, 87.7% of them were male and the rate of non squamous carcinoma was 58.2%. The median follow up period was 44 months, median OS and median PFS was 11 months (9.85-12.15) and 6 months (5.42-6.58), respectively. In multivariate analyses revealed that ECOG PS ≥ 2 (p = 0.014), high LDH level(p = 0.047), serum albumin 10.5g/dL (p = 0.011), number of metastasis > 2 (p 3 (p Conclusions: LPI is an independent prognostic index for advanced NSCLC and might be helpful to predict the survival when combined with clinical parameters. LPI is an inexpensive an easily accessible indicator which might be used for treatment decisions and patient follow-up. Disclosure: All authors have declared no conflicts of interest.

Assessment of serum thiol/disulfide homeostasis in multiple myeloma patients by a new method.

Objectives: The etiology of multiple myeloma (MM) is not exactly known. This study investigated the role of thiol/disulfide homeostasis in the etiopathogenesis of MM. Methods: Some 50 patients with MM (aged 39–84 years) and 50 sex-matched healthy volunteer controls (aged 50–91 years) participated in this study. Venous blood samples were collected, and levels of native thiols, total thiols, and disulfide were measured. Results: Native and total thiol levels in the control group were determined to be higher than in the study and patient groups (P<0.001). Disulfide levels were found to be higher in the control group than in the study group and higher in newly diagnosed patients than in outpatients who were undergoing treatment (P=0.002). The ratios of thiol levels were found to be similar in both the study and control groups (P>0.05). Discussion: The results of the study show that although there was a decrease in the levels of disulfide, native thiol, and total thiol, the balance of thiol/disulfide was maintained. This is the first study to research the homeostasis of dynamic thiol/disulfide from the perspective of the new method that was used. We hope that this study will encourage and facilitate further studies in this area.

Neutrophil to lymphocyte ratio--not an independent prognostic factor in patients with the myelodysplastic syndrome.

PURPOSE Neutrophil-to-lymphocyte ratio (NLR) was evaluated as a potential prognostic factor in patients with myelodysplastic syndrome (MDS). MATERIALS AND METHODS Between December 2009 and April 2014, 14 female (35%) and 26 male (65%) MDS patients who were followed up in our hematology clinic were included in the study for NLR during diagnosis. Division was into two groups according to the NLR, and the correlation with mortality was evaluated. The prognostic significance of NLR regarding treatment outcome was also evaluated with adjustment for known confounding risk factors. RESULTS The mortality rate of the patient group was 55%, and median survival was 18 months. There was no significant correlation between mortality and NLR at a median value of 1.8 (p=0.75). Thrombocytopenia was observed to increase mortality (p=0.027), and there was a significant correlation between mortality and pancytopenia (p=0.017). CONCLUSIONS This first study of NLR and mortality did not show any significant correlation . In centres with limited access to genetic evaluation for the presence of pancytopenia and/or thrombocytopenia at the time of diagnosis, a platelet level less than 50?109/l may be poor prognostic markers in MDS patients.

Hospitalization Risk According to Geriatric Assessment and Laboratory Parameters in Elderly Hematologic Cancer Patients

BACKGROUND Utilizing geriatric screening tools for the identification of vulnerable older patients with cancer is important. The aim of this study is to evaluate the hospitalization risk of elderly hematologic cancer patients based on geriatric assessment and laboratory parameters. MATERIALS AND METHODS In this cross sectional study 61 patients with hematologic malignancies, age 65 years and older, were assessed at a hematology outpatient clinic. Standard geriatric screening tests; activities of daily living (ADL), instrumental activities of daily living (IADL), Mini Nutritional Assessment (MNA), Mini Mental State Examination (MMSE), timed up and go test (TUG), geriatrics depression scale (GDS) were administered. Demographic and medical data were obtained from patient medical records. The number of hospitalizations in the following six months was then recorded to allow analysis of associations with geriatric assessment tools and laboratory parameters. RESULTS The median age of the patients, 37 being males, was 66 years. Positive TUG test and declined ADL was found as significant risk factors for hospitalization (p=0.028 and p=0.015 respectively). Correlations of hospitalization with thrombocytopenia, vitamin B12 and folic acid deficiency were statistically significant (p=0.004, p=0.011 and p=0.05 respectively). CONCLUSIONS In this study, geriatric conditions which are usually unrecognized in a regular oncology office visit were identified. Our study indicates TUG and ADL might be use as predictive tests for hospitalization in elderly oncology populations. Also thrombocytopenia, and vitamin B12 and folic acid deficiencies are among the risk factors for hospitalization. The importance of vitamin B12 and folic acid vitamin replacement should not be underestimated in this population.

The relationship between plasma interleukin-15 levels and sarcopenia in outpatient older people

Background and aimSarcopenia is a geriatric syndrome in which there is a decrease in muscle mass, muscle strength, and muscle function. Interleukin-15 (IL-15), a myokine released by skeletal muscle, has effects on both muscle and adipose tissue. We evaluated the relationship between plasma IL-15 level and sarcopenia.MethodsWe evaluated a total of 160 outpatient older people, and 80 of whom had sarcopenia. Sarcopenia was defined according to the European Working Group on Sarcopenia in Older People criteria. Plasma IL-15 was measured by enzyme-linked immunosorbent assay. Activities of daily living, nutritional and exercise status, co-morbidities, body mass index, waist circumference, sensitive C-reactive protein, IL-6, and vitamin D levels were also evaluated.ResultsIL-15 levels were significantly higher in control subjects [5.1 (2.75–18.69)] compared to sarcopenic participants [3.91 (2.07–15.56)] (p < 0.001). Plasma IL-15 levels were independently and inversely associated with sarcopenia in multivariate regression analysis [OR: 0.74 (CI 95% 0.6–0.91) p = 0.005]. Age [OR: 1.13 (CI 95% 1.01–1.27) p = 0.03] and BMI [OR: 0.68 (CI 95% 0.51–0.92)] were also associated with sarcopenia in multivariate regression analysis.Conclusions and discussionA low level of plasma IL-15 is associated with sarcopenia in outpatient older people. Further longitudinal and prospective studies are needed to evaluate changes in IL-15 over time together with muscle mass and strength or therapeutic potential of IL-15.

Severe Hyponatremia After Desmopressin Diacetate Arginine Vasopressin Infusion in an Older Woman.

need to be considered because of the potential for crossreactivity. In this woman, haloperidol and risperidone were given safely. Olanzapine and clozapine were avoided because of their structural similarity to quetiapine, although cross-reactivity has been reported with olanzapine and risperidone, underscoring the need for careful monitoring because the risk of skin reactions to different chemical classes can be unpredictable. This case highlights the diagnostic challenges and therapeutic implications of a rare adverse reaction to a drug prescribed off label for the pharmacological treatment of BPSDs. A high index of suspicion should be maintained for drug-related causes of cutaneous small vessel vasculitis. Given the potential morbidity associated with use of antipsychotics, a careful balance needs to be struck between benefits of symptom control and development of adverse effects.

Angiotensin 1–7 and risk for breast cancer recurrence

We read with great interest the article by Rodgers et al. [3]. In their phase I/II dose escalation study, they tried to determine the safety and efficacy of Angiotensin 1–7 in patients with breast cancer. Their data showed that Angiotensin 1–7 might be beneficial in attenuating multilineage cytopenias following chemotherapy at a dose of 100 lg/kg per day. Although Angiotensin 1–7 is a hematopoietic agent that stimulates the proliferation of multipotential and differentiated progenitor cells in cultured bone marrow and human cord blood, Angiotensin-II, analog of Angiotensin 1–7 has a wide spectrum of target tissues, including breast epithelial cells. It acts as a growth factor both in normal and cancer epithelial cells and promotes angiogenesis [2, 4]. The presence of undetected micrometastases, isseminated before or around the time women receive local treatment for ‘early’ breast cancer, is assumed to be the reason why many subsequently develop overt distant metastases ultimately causing death. Adjuvant chemotherapy can reduce recurrence rates and improve survival for some women [1]. Taken all together, since Angiotensin has a stimulatory effect on the growth of breast cancer cells, giving Angiotensin 1–7 for attenuation of multilineage cytopenias following chemotherapy might additionally increase angiogenesis around the micrometastatic cells and excite them to proliferate as well. Therefore, use of Angiotensin 1–7 as a growth factor for hematopoitic system might be cautioned. We believe that further studies are needed to confirm its effects on long-term survival of breast cancer patients.