Mehmet Aliustaoglu

Patient satisfaction in the outpatients' chemotherapy unit of Marmara University, Istanbul, Turkey: a staff survey

BackgroundWe conducted a survey to find out how patients feel about the care they receive in the outpatient chemotherapy unit of Marmara University Hospital.MethodsThe American College of Physicians Patient Satisfaction survey translated into Turkish was used. A meeting was held with all involved staff, before conducting the survey, to review the purpose and determine the process. The study was conducted with 100 random patients.ResultsConsistent with cancer frequency, most patients had either lung, colorectal or breast cancer. Their insurance was government sponsored in close to 90%. The educational levels were above Turkish median but consistent with the area the hospital is serving. They were coming to the unit on average 8.5 months. The responses were not influenced by the surveyed diagnosis, age, sex or educational status (p > 0,05). Particularly health care teams attention, trust and courtesy came forward as strong points. The weaknesses noted as difficulties in booking an outpatient doctor visit appointment because the phone line was busy or the secretary was not courteous, the excessive amount of time and effort it required to get laboratory and radiology results.ConclusionThe health care system is basically a service based industry and customer satisfaction is at utmost importance just as in other service-oriented sectors. We hope this study will shed light in that area and Turkish health care providers will pay closer attention to how their patients feel about the services that they are getting.

Results of paclitaxel (day 1 and 8) and carboplatin given on every three weeks in advanced (stage III-IV) non-small cell lung cancer

BackgroundBoth paclitaxel (P) and carboplatin (C) have significant activity in non-small cell lung cancer (NSCLC). The weekly administration of P is active, dose intense, and has a favorable toxicity profile. We retrospectively reviewed the data of 51 consecutive patients receiving C and day 1 and 8 P chemotherapy (CT) regimen in advanced stage NSCLC to evaluate the efficacy and toxicity.MethodsPatients treated in our institutions having pathologically proven NSCLC, no CNS metastases, adequate organ function and performance status (PS) ECOG 0–2 were given P 112.5 mg/m2 intravenously (IV) over 1 hour on day 1 and 8, followed by C AUC 5 IV over 1 hour, repeated in every three weeks. PC was given for maximum of 6 cycles.ResultsMedian age was 58 (age range 39–77) and 41 patients (80%) were male. PS was 0/1/2 in 29/17/5 patients and stage was IIIA/IIIB/IV in 3/14/34 patients respectively. The median number of cycles administered was 3 (1–6). Seven patients (14%) did not complete the first 3 cycles either due to death, progression, grade 3 hypersensitivity reactions to P or lost to follow up. Best evaluable response was partial response (PR) in 45% and stable disease (SD) in 18%. Twelve patients (24%) received local RT. Thirteen patients (25%) received 2nd line CT at progression. At a median follow-up of 7 months (range, 1–20), 25 (49%) patients died and 35 patients (69%) progressed. Median overall survival (OS) was 11 ± 2 months (95% CI; 6 to 16), 1-year OS ratio was 44%. Median time to progression (TTP) was 6 ± 1 months (95% CI; 4 to 8), 1-year progression free survival (PFS) ratio was 20%. We observed following grade 3 toxicities: asthenia (10%), neuropathy (4%), anorexia (4%), anemia (4%), hypersensitivity to P (2%), nausea/vomiting (2%), diarrhea (2%) and neutropenia (2%). Two patients (4%) died of febrile neutropenia. Doses of CT were reduced or delayed in 12 patients (24%).ConclusionsP on day 1 and 8 and C every three weeks is practical and fairly well tolerated outpatient regimen. This regimen seems to be comparably active to regimens given once in every three weeks.

D-dimer--can it be a marker for malignant gastric lesions?

(14 of these had metastasis), 5 (14%) had stage IIIB, 7 (20%) had IIIA, and 2 (6%) had stage II disease. Plasma D-dimer levels were significantly higher in patients with malignant gastric lesions (5.159 /10.46 mcg/ml [range: 0.22 � /40.75 mcg/ml] for adenocarcinoma vs 0.759 /1.09 mcg/ml [range: 0.04 � /4.72 mcg/ml] for benign lesions, p B /0.001). This was also true for patients with stages I to III gastric cancer compared with benign lesions (1.369 /1.16 mcg/ml for stages I to III patients vs 0.759 /1.09 mcg/ml for benign lesions; pB /0.001). The cut-off point of 0.585 mcg/ml was selected as best lower than median D-dimer level for benign lesions. The group with gastric cancer and the group with benign gastric diseases were used to calculate sensitivity and specificity. The sensitivity at a D-dimer level of 0.585 mcg/ml was 86% (95% confidence interval 71% to 95%). The specificity at this value was 81% (95% confidence interval 64% to 93%). The positive and the negative predictive value were both 84%. There were 29 patients with gastric cancer whose levels were 0.585 mcg/ml, while only 6

Human papilloma virus: Is it a new etiological factor in breast cancer?

9635 Background: Viruses are known to be associated with human malignancies, e.g.,; Epstein-Barr virus, human papilloma virus (HPV) and human T-cell leukemia virus type I. HPV DNA has been found in uterine cervix, anogenital, oral cavity and esophagus tumors. HPV also has been shown to immortalize the breast epithelial cells and increase their proliferation in vitro. We conducted a prospective study to define the role of HPV in breast cancer.nnnMATERIALS AND METHODSnThe malignant and normal breast tissue samples of 30 consecutive breast cancer patients were obtained postoperatively within the 1st hour of operation. All tissue samples were proven to be invasive ductal/lobular carcinoma histopathologically. DNA extracted from all tissues was amplified with the polymerase chain reaction using HPV consensus primer (MY11; 5GCMCAGGGWCATAAYAATGG-3; MY9; 5CGTCCMARRGGAWACTGATC-3) and HPV type specific primers. HPV 11, 16, 18, 33 subtypes were searched in HPV-DNA positive samples.nnnRESULTSnThe median age was 53 (range 30-75). Twenty-five samples (83.3%) of tumoral breast tissue expressed HPV-DNA, 13 normal breast tissue samples (43.3%) were positive as well. But there was a significant difference in HPV-DNA positivity between normal and tumoral breast tissue samples (p= 0.003; Fishers exact test). HPV 18 was detected in 20 of the HPV-DNA positive tumoral tissue (80%) and in 9 of the HPV-DNA positive normal tissue (69.2%) (p=0.689). HPV-33 also was detected in 24 (96 %) of the HPV-DNA positive tumoral tissue and in 12 (92.3 %) of the HPV-DNA positive normal tissue samples (p= 1.000). The distribution of HPV types 18 and 33 between the normal tissue and tumoral tissue was not significantly different. HPV-11 and 16 were not found in any of the HPV-DNA positive samples.nnnCONCLUSIONnHPV DNA was significantly associated with breast tumor tissue compared to normal breast tissue. Our study could not define the specific HPV subtype involved in breast cancer etiology due to the small number of samples and the possible presence of other HPV subtypes which are not analyzed in the present study. Additional studies looking at other HPV subtypes are needed to clarify the etiological role of the HPV in breast cancer. No significant financial relationships to disclose.

Paclitaxel (P) (day 1 and 8) and carboplatin (C) given on every 3 weeks in advanced (stage III-IV) non-small cell lung cancer (NSCLC)

7321 Background: Both P and C have significant activity in NSCLC. Earlier reports on the weekly administration of P showed that it is active, dose intense, and has a favorable toxicity profile. We reviewed the efficacy and toxicity of this combination in 51 patients with advanced stage NSCLC.nnnMETHODSnEligible patients had pathologically proven NSCLC, stage III, IV disease, no CNS metastases, adequate organ function and performance status (PS) ECOG 0-2. Patients were treated with P 112.5mg/m2 iv. over 1 hour on day 1 and 8, followed by C AUC 5-6 iv. over 1 hour, repeated in every 3 weeks. PC was given for maximum of 6 courses.nnnRESULTSnMedian age was 58 (39-77), 41 patients (80.4%) were male. PS was 0/1/2 in 29/17/5 patients and stage was IIIA/IIIB/IV in 3/14/34 patients, respectively. Histology was squamous cell in 18, adenocarcinoma in 16, undifferentiated in 16 and adenosquamous in 1. The median number of cycles administered was 3 (range, 1-6). Eight patients (15.6%) did not complete the first 3 cycles either due to death (2), progression (3), grade 3 hypersensitivity reaction to P (1) or lost to follow up (2). Best evaluable response was PR in 45% and SD in 15.6%. Nine patients (18%) with stage III disease received local RT. Eleven patients received 2nd line CT at progression. At a median follow-up of 5 months (1-17), 17 patients died. Median overall survival (OS) was 12±3 months (95%CI; 7 to17), 1-year OS ratio was 48%. Median time to progression (TTP) was 5±1 months (95%CI; 4 to 6), 1-year TTP ratio was 20.5%. Most frequent toxicity related symptoms were asthenia (60%), neuropathy (37%) and anorexia (35%). Grade 3 toxicities: asthenia (10%), neuropathy (4%), anorexia (4%), hypersensitivity to P (2%), nausea/vomiting (2%), anemia (4%) and neutropenia (2%). Grade 5 (fatal) febrile neutropenia was observed in 2 patients (4%). Dose of CT was reduced or delayed in 11 patients (21.6%).nnnCONCLUSIONnP on day 1 and 8 and C every 3 weeks is well tolerated and moderately active regimen in patients with advanced stage NSCLC. Patients need to be followed carefully with blood counts during treatment. No significant financial relationships to disclose.

Prognostic value of thymidylate synthase and cox-2 expression in colorectal cancer patients' tumors

3731 Background: Colorectal cancer (CRC) is a major health problem in the world for both men and women due to its high incidence and limited benefit with chemotherapy when the disease recurs. There is a need for progress in assessment of the prognosis of patients and predict who would benefit from treatment. In this study, the value of molecular markers thymidylate synthase (TS) and cox-2 were evaluated as prognostic predictors in patients with stage II and III CRC.nnnPATIENTS AND METHODSnWe retrospectively analyzed the prognostic value of TS and cox-2 in 49 patients with stage II (n=23) and III (n=26) CRC. They were treated with either surgery alone or surgery followed by adjuvant fluorouracil and leucovorin chemotherapy in Marmara University Hospital, Medical Oncology Department between April 1997 and 2003. A specialized pathologist evaluated these markers using immunohistochemical techniques. Samples were scored as high and low TS and Cox-2 intensity according to their staining properties.Low intensity: No staining or less than 10% of tumoral cells are stained. High intensity: More than 10% of tumoral cells are stained.nnnRESULTSnHigh TS intensity was found in 20.4% of tumor samples with mucinous component and in 64.1% without mucinous component (p=0.01). In patients whose tumor samples had low or high TS intensity 5 year overall survival was 61.5% and 37.5% respectively (p=0.86). Also with low or high cox-2 intensity, overall 5-year survival did not improved (40% vs 70.6%) statistically (p=0.72). More patients with high TS staining tumors relapsed compared to those with low TS staining (p=0.01).nnnCONCLUSIONSnAlthough we did not find a significant relationship between TS, cox-2 and overall survival, statistically significant RFS rates are suggestive of a correlation if these markers are studied in a greater sample size. No significant financial relationships to disclose.