Chow E.,University of Toronto |
Nguyen J.,University of Toronto |
Zhang L.,University of Toronto |
Tseng L.-M.,Taipei Veterans General Hospital |
And 9 more authors.
Cancer | Year: 2012
Background: The objective of this international field study was to test the reliability, validity, and responsiveness of the European Organization for Research and Treatment of Cancer (EORTC) QLQ-BM22 module to assess health-related quality of life (HRQOL) in patients with bone metastases. Methods: Patients undergoing a variety of bone metastases-specific treatments were accrued. The QLQ-BM22 was administered with the QLQ-C30 at baseline and at 1 follow-up time point internationally. A debriefing questionnaire was administered to determine patient acceptability and understanding. Results: Large-scale field testing of the QLQ-BM22 in addition to the QLQ-C30 took place in 7 countries: Brazil, Canada, Cyprus, Egypt, France, India, and Taiwan. A total of 400 patients participated. Multitrait scaling analyses confirmed 4 scales in the 22-item module. The scales were able to discriminate between clinically distinct patient groups, such as between those with a poor and those with a better performance status. The QLQ-BM22 was well received in all 7 countries, and the majority of patients did not recommend any significant changes from the module in its current form. Conclusions: The final QLQ-BM22 module contains 22 items and 4 scales assessing Painful Sites, Painful Characteristics, Functional Interference, and Psychosocial Aspects. Results confirmed the validity, reliability, cross-cultural applicability, and sensitivity of the 22-item EORTC QLQ-BM22. It is therefore recommended that the QLQ-BM22 be used in addition to the QLQ-C30 in clinical trials to assess HRQOL in patients with bone metastases. © 2011 American Cancer Society.
Vassiliou V.,Bank of Cyprus Oncology Center |
Kardamakis D.,University of Patras
Strahlentherapie und Onkologie | Year: 2010
Background: Bisphosphonate (BP) use has increased dramatically in recent years, becoming an integral part of the overall antineoplastic management of patients with metastatic bone disease. Even though their application has shown to be effective in reducing pain and minimizing the risk of skeletal-related events, their administration may bring also adverse events such osteonecrosis of the jaws (ONJ). Methods: After a thorough review of the literature, important aspects of the pathophysiology, diagnosis, prevention, and treatment of ONJ are presented. Results: ONJ is evident in up to 10% of patients receiving intravenous BP treatment. Despite the fact that its exact pathophysiology is unknown, it is characterized by bone necrosis that can occur either spontaneously or after dental surgery or tooth extraction. Panoramic radiographs are useful for the diagnosis and routine assessment of patients and computed tomography can differentiate between ONJ and metastatic disease. Additionally, magnetic resonance imaging depicts local disease extension readily, and scintigraphy is the most sensitive imaging modality for detecting early involvement. Preventive measures and routine dental evaluations are essential components of the overall patient management. In the event of ONJ, stage I or II should be managed conservatively, whereas more advanced stages (III and IV) should be treated surgically. Conclusion: ONJ is a well-defined clinical entity that all medical and dental doctors should be aware of, since if it is not dealt with readily and effectively, it may deteriorate the clinical status and quality of life of affected patients. © 2010 Urban & Vogel, Muenchen.
Reichardt P.,Interdisciplinary Oncology |
Blay J.-Y.,Center Leon Berard |
Boukovinas I.,Theagenion Cancer Hospital |
Brodowicz T.,Medical University of Vienna |
And 11 more authors.
Annals of Oncology | Year: 2012
Background: The management of primary gastrointestinal stromal tumours (GISTs) has evolved with the introduction of adjuvant therapy. Recently reported results of the SSG XVIII/AIO trial by the Scandinavian Sarcoma Group (SSG) and the German Working Group on Medical Oncology (AIO) represent a significant change in the evidence for adjuvant therapy duration. The objectives of this European Expert Panel meeting were to describe the optimal management and best practice for the systemic adjuvant treatment of patients with primary GISTs. Materials and methods: A panel of medical oncology experts from European sarcoma research groups were invited to a 1-day workshop. Several questions and discussion points were selected by the organising committee prior to the conference. The experts reviewed the current literature of all clinical trials available on adjuvant therapy for primary GISTs, considered the quality evidence and formulated recommendations for each discussion point. Results: Clinical issues were identified and provisional clinical opinions were formulated for adjuvant treatment patient selection, imatinib dose, duration and patient recall, mutational analysis and follow-up of primary GIST patients. Adjuvant imatinib 400 mg/day for 3 years duration is a standard treatment in all patients with significant risk of recurrence following resection of primary GISTs. Patient selection for adjuvant therapy should be based on any of the three commonly used patient risk stratification schemes. R1 surgery (versus R0) alone is not an indication for adjuvant imatinib in low-risk GIST. Recall and imatinib restart could be proposed in patients who discontinued 1-year adjuvant imatinib within the previous 3 months and may be considered on a case-by-case basis in patients who discontinued within the previous year. Mutational analysis is recommended in all cases of GISTs using centralised laboratories with good quality control. Treatment is not recommended in an imatinib-insensitive D842V-mutated GIST. During adjuvant treatment, patients are recommended to be clinically assessed at 1- to 3-month intervals. Upon discontinuation, computed tomography scan (CT) scans are recommended every 3 to 4 months for 2 years when the risk of relapse is highest, followed by every 6 months until year 5 and annually until year 10 after treatment discontinuation. Conclusions: Key points in systemic adjuvant treatment and clinical management of primary GISTs as well as open questions were identified during this European Expert Panel meeting on GIST management. © The Author 2012. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved.
Iliopoulou E.G.,Saint Savas Cancer Hospital |
Kountourakis P.,Saint Savas Cancer Hospital |
Kountourakis P.,Bank of Cyprus Oncology Center |
Karamouzis M.V.,Saint Savas Cancer Hospital |
And 7 more authors.
Cancer Immunology, Immunotherapy | Year: 2010
HLA-mismatched natural killer (NK) cells have shown efficacy in acute myeloid leukemia, and their adoptive transfer in patients with other malignancies has been proven safe. This phase I clinical trial was designed to evaluate safety (primary endpoint) and possible clinical efficacy (secondary endpoint) of repetitive administrations of allogeneic, in vitro activated and expanded NK cells along with chemotherapy in patients with advanced non-small cell lung cancer (NSCLC). Patients with unresectable, locally advanced/metastatic NSCLC receiving 1st/2nd line chemotherapy were eligible to receive 2-4 doses of activated NK cells from two relative donors. Donor's CD56+ cells were cultured for 20-23 days with interleukin-15 (IL-15) and hydrocortisone (HC) and administered intravenously between chemotherapy cycles. Premedication with corticosteroids and/or H1 inhibitors was allowed. Sixteen patients (performance status 0-1) with adenocarcinoma (n = 13) or squamous cell carcinoma (n = 3) at stage IIIb (n = 5) or IV (n = 11) receiving 1st (n = 13) or 2nd (n = 3) line treatment were enrolled. Fifteen patients received 2-4 doses of allogeneic activated NK cells (0.2-29 × 10 6/kg/dose, median 4.15 × 106/kg/dose). No side effects (local or systemic) were observed. At a median 22-month follow-up (range, 16.5-26 months) 2 patients with partial response and 6 patients with disease stabilization were recorded. Median progression free survival and overall survival were 5.5 and 15 months, respectively. A 56% 1-year survival and a 19% 2-year survival were recorded. In conclusion, repetitive infusions of allogeneic, in vitro activated and expanded with IL-15/HC NK cells, in combination with chemotherapy are safe and potentially clinically effective. © 2010 Springer-Verlag.
Demetriou C.A.,The Cyprus Institute of Neurology and Genetics |
Demetriou C.A.,Imperial College London |
Hadjisavvas A.,The Cyprus Institute of Neurology and Genetics |
Loizidou M.A.,The Cyprus Institute of Neurology and Genetics |
And 7 more authors.
BMC Cancer | Year: 2012
Background: Diet has long been suspected to impact on breast cancer risk. In this study we evaluated whether the degree of adherence to a Mediterranean diet pattern modifies breast cancer risk amongst Greek-Cypriot women.Methods: Subjects included 935 cases and 817 controls, all participating in the MASTOS case-control study in Cyprus. The study was approved by the Cyprus National Bioethics Committee. Information on dietary intakes was collected using an interviewer administered 32-item Food Frequency Questionnaire. Information on demographic, anthropometric, lifestyle, and other confounding factors was also collected. Adherence to the Mediterranean Diet pattern was assessed using two a-priory defined diet scores. In addition, dietary patterns specific to our population were derived using Principal Component Analysis (PCA). Logistic regression models were used to assess the association between the dietary patters and breast cancer risk.Results: There was no association with breast cancer risk for either score, however, higher consumptions of vegetables, fish and olive oil, were independently associated with decreased risk. In addition, the PCA derived component which included vegetables, fruit, fish and legumes was shown to significantly reduce risk of breast cancer (ORs across quartiles of increasing levels of consumption: 0.89 95%CI: 0.65-1.22, 0.64 95%CI: 0.47-0.88, 0.67 95%CI: 0.49-0.92, P trend < 0.0001), even after adjustment for relevant confounders.Conclusions: Our results suggest that adherence to a diet pattern rich in vegetables, fish, legumes and olive oil may favorably influence the risk of breast cancer. This study is the first investigation of dietary effects on breast cancer risk in Cyprus, a country whose population has traditionally adhered to the Mediterranean diet. © 2012 Demetriou et al; licensee BioMed Central Ltd.
Papademetriou K.,Bank of Cyprus Oncology Center |
Ardavanis A.,Saint Savas Anticancer Hospital |
Kountourakis P.,Bank of Cyprus Oncology Center
Journal of Thoracic Disease | Year: 2010
Despite progress achieved in diagnosis and therapy in recent years, locally advanced breast cancer (LABC) remains a major clinical issue. Biological characteristics and clinical behavior varies widely, ranging from indolent to locally aggressive or generalized disease. In depth knowledge of biology of cancer progression and cancer could lead to the identification of tumor characteristics associated with outcome. Neoadjuvant chemotherapy (NCT) integrated into a multimodality program is nowadays the established treatment in LABC. Although our efforts in this research task are ongoing, of special clinical interest is the integration of anti-HER2 and other biological therapies, as anti-angiogenesis targeted treatments, that may further improve the long term control of LABC. Clinical management of LABC could be modified based on molecular biology and an approach tailored to each patient will optimize therapy.
Vassiliou V.,Bank of Cyprus Oncology Center |
Andreopoulos D.,Bank of Cyprus Oncology Center |
Frangos S.,Bank of Cyprus Oncology Center |
Tselis N.,Klinikum Offenbach |
And 2 more authors.
Clinical Oncology | Year: 2011
Radiological and nuclear medicine imaging modalities used for assessing bone metastases treatment response include plain and digitalised radiography (XR), skeletal scintigraphy (SS), dual-energy X-ray absorptiometry (DEXA), computed tomography (CT), magnetic resonance imaging (MRI), [ 18F] fluorodeoxyglucose positron emission tomography (FDG-PET) and PET/CT. Here we discuss the advantages and disadvantages of these assessment modalities as evident through different clinical trials. Additionally, we present the more established response criteria of the International Union Against Cancer and the World Health Organization and compare them with newer MD Anderson criteria. Even though serial XR and SS have been used to assess the therapeutic response for decades, several months are required before changes are evident. Newer techniques, such as MRI or PET, may allow an earlier evaluation of response that may be quantified through monitoring changes in signal intensity and standard uptake value, respectively. Moreover, the application of PET/CT, which can follow both morphological and metabolic changes, has yielded interesting and promising results that give a new insight into the natural history of metastatic bone disease. However, only a few studies have investigated the application of these newer techniques and further clinical trials are needed to corroborate their promising results and establish the most suitable imaging parameters and evaluation time points. Last, but not least, there is an absolute need to adopt uniform response criteria for bone metastases through an international consensus in order to better assess treatment response in terms of accuracy and objectivity. © 2011 The Royal College of Radiologists.
Charalambous H.,Bank of Cyprus Oncology Center |
Protopapa E.,University College London |
Gavrielidou D.,Bank of Cyprus Oncology Center |
Avgousti V.,Bank of Cyprus Oncology Center
Annals of Oncology | Year: 2012
Background: Prescription of opioids based on morphine equivalence data per capita is very low in Cyprus. Three studies were undertaken to evaluate the prescribing habits of physicians in Cyprus for cancer patients with pain. Methods: Data were collected regarding the presence and severity of pain and prescription of analgesia in a cross-sectional study of 141 patients receiving outpatient chemotherapy within the Bank of Cyprus Oncology Centre (BOCOC), in a retrospective study of 90 new lung cancer patients referred to one Oncologist in the BOCOC, and in a prospective study of 100 new cancer patients referred to the BOCOC. In the first study, the results reflected the prescribing habits of oncologists within the oncology centre, whilst the second and third studies reflected the prescribing habits of physicians outside the oncology centre. Results: In the three studies, 56.0%, 48.1% and 57.7%, respectively, of patients with pain were prescribed analgesia. The majority of patients were prescribed paracetamol and non-steroidal anti-inflammatory drugs, and only 8.6%, 11.5% and 0%, respectively, of patients were prescribed strong opioids. In the last two studies, following their oncology appointment the prescription of analgesia to patients with pain, increased to 80.8% and 73.1%, respectively, whilst the prescription of strong opioids, increased to 28.8% and 34.6%, respectively, reflecting oncologists' practice. Conclusion: There is under-treatment of pain in cancer patients, both within and outside a tertiary oncology centre in Cyprus. Particularly there is low prescribing of strong opioids. There is a need to look further into the barriers that prevent physicians prescribing opioids in Cyprus, as well as to patients' attitudes towards analgesia and opioids, and to set up training programs to address these issues. © The Author 2012. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved.
Giannousi Z.,Bank of Cyprus Oncology Center |
Karademas E.C.,University of Crete |
Dimitraki G.,University of Crete
Journal of Behavioral Medicine | Year: 2016
The aim was to examine the impact of the dyadic, interaction and dissimilarity effects of the illness representations on the psychological health of recently diagnosed cancer patients and spouses in Greece. The sample consisted of 298 individuals nested in 149 couples. Effects were examined with the Actor–Partner Interdependence Model. Both actor (i.e., within person) and partner (i.e., between partners) effects were detected for both patients’ and spouses’ psychological symptoms. The negative association of patients’ psychological symptoms with their representations of illness coherence was weak at the higher and medium levels, and stronger at the lower levels of spouse corresponding representations. Patient–partner discrepancy in perceived illness consequences was associated with more psychological symptoms in patients. Adaptation to cancer is a dyadic process within the context of which patient and partner psychological well-being is affected by each other’s understanding of illness. Thus, the parallel examination of the illness representations of both partners is needed from the early phases of the illness trajectory. © 2015, Springer Science+Business Media New York.
Vassiliou V.,Bank of Cyprus Oncology Center
Clinical Oncology | Year: 2013
The life expectancy of Western populations has risen in the last few decades, resulting in a steep increase in the number of elderly cancer patients. Metastatic bone disease (MBD) is an important problem in such patients as it is associated with the development of skeletal-related events (SREs), such as fractures and spinal cord compression. These complications do not only deteriorate the quality of life of affected patients, but can also reduce expected survival. Due to the fact that elderly patients have an increased risk of SREs, maintaining bone health and implementing effective treatments for managing MBD is of vital importance. Bisphosphonates have been shown to be effective in reducing the risk of SREs considerably in patients with MBD. Moreover, they have been shown to reduce pain and improve the quality of life of affected patients. Bisphosphonates should be used with caution in elderly patients due to the fact that their use can bring about renal function deterioration. Several preventive measures need to be followed in order to minimise the risk of this complication. Denosumab is a monoclonal antibody inhibiting receptor activator of NF-kB ligand and has shown superiority over zoledronic acid in reducing the risk of SREs. In the three comparative trials between denosumab and zoledronic acid, survival and disease progression were similar between the two groups. Denosumab has been shown not to affect renal function and can therefore be safely used in the elderly. Osteonecrosis of the jaws is a devastating complication that may occur after treatment with either denosumab or zoledronic acid. The incidence rates between the two are comparable and percentage differences not statistically significant. In the three randomised trials, hypocalcaemia occurred more frequently in denosumab-treated patients than in those managed with zoledronic acid, with the corresponding percentages being 5.5-13% versus 3.4-6%. In order to minimise the risk of osteonecrosis of the jaws and hypocalcaemia, all precautionary measures and treatment guidelines should be followed closely. Several studies have investigated the cost-effectiveness of denosumab versus zoledronic acid when used for SRE prevention. These studies reported contradictory results due to the application of different analytical perspectives and model parameters. © 2013 The Royal College of Radiologists.