Rezwan Islam

Modeling efficacy of bevacizumab treatment for metastatic colon cancer.

Purpose: Bevacizumab, an FDA-approved adjuvant treatment for metastatic colon cancer, has extended survival for many patients. However, factors predicting response to treatment remain undefined. Patients and Methods: Relevant clinical and environmental data were abstracted from medical records of 149 evaluable patients treated with bevacizumab for metastatic colon cancer at a multi-specialty clinic. Tumor response was calculated from radiologic reports using Response Evaluation Criteria in Solid Tumors (RECIST) criteria and verified by oncologist review. Patients with at least one occurrence of complete or partial response or stable disease were classified as responders; those exhibiting progressive disease were classified as non-responders. Results: Univariate analysis demonstrated that blood in stool (P<0.05), unexplained weight loss (P<0.05), primary colon cancer site (P<0.05), chemotherapy treatment of primary tumor site (P<0.05), and adenocarcinoma versus adenoma subtype (P<0.05) was associated with tumor responsiveness. Factors remaining statistically significant following multivariate modeling included adenocarcinoma as tumor cell type versus other adenocarcinoma subtypes (OR=6.35, 95% CI: 1.08-37.18), chemotherapy treatment applied to primary tumor (OR= 0.07, 95% CI: 0.0-0.76,), tumor localization to cecal/ascending colon (OR=0.061, 95% CI: 0.006-0.588,), and unexplained weight loss (OR=0.1, 95% CI: 0.02-0.56,). Chemotherapy treatment of primary tumor, unexplained weight loss, and cecal/ascending localization of the tumor were associated with poorer outcomes. Adenocarcinoma as cell type compared to other adenocarcinoma subtypes was associated with better response to bevacizumab treatment. Conclusion: Results suggest that response to bevacizumab therapy may be predicted by modeling clinical factors including symptomology on presentation, tumor location and type, and initial response to chemotherapy.

Usability of mobile computing technologies to assist cancer patients

Medical researchers are constantly looking for new methods for early detection and treatment of incurable diseases. Cancer can severely hinder the lives of patients if they are not constantly attended to. Cancer patients can be assisted with the aid of constant monitoring by a support group and a continual sense of self-awareness through monitoring, which can be enabled through pervasive technologies. As human life expectancy rises, incidents of cancer also increase, which most often affects the elderly. Cancer patients need continuous follow-up because of the state of their disease and the intensity of treatment. Patients have often restricted mobility, thus it is helpful to provide them access to their health status without the need to travel. There has been much effort towards wireless and internet based health care services, but they are not widely accepted due to the lack of reliability and usability. In this paper, we present a software called Wellness Monitor (WM). The purpose of WM is to utilize the portability and ubiquity of small handheld devices such as PDAs, cell phones, and wrist watches to ensure secured data availability, customized representation, and privacy of the data collected through small wearable sensors. WM explores how the social and psychological contexts that encompass the patients could be enhanced by utilizing the same technology, an aspect which is mostly unexplored. A further goal was to provide continuous psychological assistance.

Low-dose ruxolitinib for improving leukopaenia and reducing recurrent infections associated with myelofibrosis

Myelofibrosis, either primary or resulting from essential thrombocythemia or polycythemia vera, may present with highly variable white blood cell counts, including progressive leukopaenia with its associated risk of infections. Medications have been developed to reduce splenomegaly and other symptoms, but there are no reports of improved white blood cell counts. We report a case of primary myelofibrosis with marked improvement in leukopaenia and reduced recurrent infections, in addition to reduction in spleen size and improvement in disease-associated symptoms, within 20 weeks after using low-dose ruxolitinib. Although reduction of splenomegaly in myelofibrosis patients is the anticipated benefit of ruxolitinib, the drug may also have the potential to improve leukopaenia if used at a low dose.

Urethral ‘recurrence’ found 14 years after radical cystectomy

Abstract  We report a case of transitional cell urethral cancer diagnosed 14 years after radical cystectomy. Traditionally, in the postcystectomy setting, these cancers have been referred to as ‘recurrences’. We review the biological models for the oncogenesis of these cancers and propose that they are typically a result of a field cancerization effect, rather than being derived from the same clone responsible for the original urothelial tumor.

Gelatinous bone marrow transformation secondary to unusual eating habits and drastic weight loss.

Gelatinous bone marrow transformation (GMT), also known as starvation bone marrow, has been reported in a number of chronic illnesses, eating disorders (anorexia nervosa) and malignancies. We report the case of a 37-year-old man with a history of bipolar disorder and obesity (weighing >300 pounds) who presented due to recently developing a deep yellow colour to his skin. Over the past 2 years, through diet and exercise, he lost over 150 pounds. He reported running 6–8 miles per day and eating ‘lots of squash’. We made the diagnosis of starvation hepatitis and bone marrow degeneration, and referred the patient to a dietician and haematologist/oncologist, where improvements were observed at 4 weeks follow-up.

The effects of age, stage, treatment, and Charlson comorbidity index (CCI) on quality of life after prostate cancer diagnosis in a single cohort.

242 Background: Long term quality of life after diagnosis of prostate cancer (PC) is an important factor in determining treatment success and satisfaction. Here we investigate the quality of life in a rural cohort of individuals treated for PC within a single institution. METHODS The Expanded Prostate Cancer Index Composite (EPIC) and the Medical Outcomes Short-Form 36 (SF 36) were completed by a rural population based cohort diagnosed with prostate cancer between January of 2005 and December of 2010, enrolled in a population based biorepository. Medical records were interrogated electronically for information such as age at treatment, stage, CCI, and first course of treatment. RESULTS Of the 173 individuals within the cohort, we received 95 completed survey instruments. No differences in age group, stage at treatment, or treatment type between individuals who completed the survey and those who did not were observed. Median summary score for the sexual domain was 10 (min -6 max 77), median summary score for urinary domain was 85 (min 36 max 100), and median summary score for the bowel domain was 95 (min 68 max 100). Median physical health score was 80 (min 20 max 100) and median general health score was 67 (min 20 max 100). Overall satisfaction score was 75 (min 25 max 100). Scores for bowel and urinary function were not significantly associated with treatment, age, CCI, or stage at diagnosis. For the sexual domain, individuals with hormonal treatment scored worse than other treatments (ttest p=0.05). Overall physical health was associated (anova, p<=0.05) with treatment, age, CCI, and stage. In a multivariate model only treatment and an interaction term with treatment and CCI were significant. Satisfaction score varied with treatment, individuals who received radiation treatment had a higher mean satisfaction score (87 vs 68 for the other groups ANOVA p=0.03). CONCLUSIONS The treatment for prostate cancer affected an individuals quality of life in the domains of physical function, and sexual health. Treatment also affected satisfaction score regardless of age or stage at diagnosis.

Age at diagnosis and treatment for prostate cancer (PC) in two distinct integrated health care systems.

240 Background: An older age at diagnosis may affect the stage at which PC is diagnosed as well as the treatment decisions made by the providers and/or the patients. Here we compare two geographically and ethnically distinct PC cohorts to determine whether age affects treatment decisions. METHODS Populations- Marshfield Clinic (MC): individuals were included in the cohort if they were diagnosed with PC between January, 2005 and December, 2010 and enrolled in a population based biorepository. Veterans Affairs (VA):- cohort included individuals diagnosed with PC between January, 2010 and December, 2010 within the Baltimore VA Medical Center (BVAMC). Retrospective chart review using electronic abstraction from the EMR was performed at each site. Statistical analysis was performed using the chi-square test for categorical variables or Fishers exact test if the cell size was under 5. RESULTS Compared to the MC population, the VA population had a younger median age at diagnosis (63 vs. 68), more African American men (63% vs. 0.5%) and exhibited higher median PSA at diagnosis (7.92 vs 5.78 ng/dL). Seventy nine percent of VA and 87% of MCpatientswere stage 1 or 2 at diagnosis (p=0.03). Stage was not associated with older age (age >/= 75) in either population. Individuals in the VA system were more likely to receive radiation (48% vs. 16%) and less likely to receive surgery than the MC population (18% vs. 59%). There were also several similarities in treatment decisions amongst these different populations. For instance, individuals with an older age (>/= 75 vs. other age categories) at diagnosis were more likely to receive non-aggressive treatments such as hormonal therapy or no treatment (>67% vs. <15% p=0.0001). Because the stage at diagnosis may affect treatment decisions, we also investigated treatments for stage 2 disease; in this category, individuals >/= 75 were still more likely to receive less aggressive treatment at both MC and BVAMC (>29% versus <3.4%, p=0.0001). CONCLUSIONS This initial analysis suggests that individuals with an older age at diagnosis are more likely to receive non-aggressive treatment even when the stage of disease is the same as that of a younger individual across two distinct patient populations.

Home-Healthcare-Network (h2n): an autonomous care-giving system for elderly people

As the worlds population ages, the number of elderly people suffering from various diseases increases. Due to a variety of reasons such as convenience or a need for security and privacy these elderly people generally prefer to avail healthcare facilities at their home. Advances in ubiquitous computing and wireless sensor networking have opened up new opportunities in healthcare systems. In-home pervasive networks may assist residents by providing memory enhancement, remote control of home appliances, medical data lookup and emergency communication. This is time to break through the physical boundaries of hospitals and bring healthcare facilities to the homes. Wireless and internet-based healthcare devices can play a vital role in this regard given that reliable, individualized systems with user-friendly interfaces are developed to enable elderly people feel comfortable with making use of novel technology. This paper presents Home Healthcare Network (H2N), a complete system integrating the abundance of existing sensor nodes and other devices with pervasive, wireless networks. Our approach focuses on improving social aspects of elderly care besides the conventional care-giving functionalities. Finally, we talk about the importance of preserving privacy of such a system and propose a primitive solution for the inclusion of privacy awareness in the system. Although H2N is basically designed to function as a healthcare aide for the elderly people, with little customization it can be used to accommodate other user groups as well.