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Granot T.,Davidoff Center | Gordon N.,Davidoff Center | Perry S.,Davidoff Center | Rizel S.,Davidoff Center | And 2 more authors.
PLoS ONE | Year: 2016

Objective: Perceptions of the role of oncology medical staff in supporting bereaved families have evolved with the transition to interdisciplinary cancer care. We investigated the interactions between oncology professionals and bereaved families. Methods: This cross-sectional study involved all oncology medical staff at the Davidoff Center. Participants were given a questionnaire relating to bereavement follow-up. Responses were measured using a 5-point Likert scale. Results: Of 155 staff members, 107 filled questionnaires with <20% missing data and were included in the analysis (α = 0.799; corrected, α = 0.821). Respondents included physicians (35%), nurses (46%), social workers (7%), psychologists (4%), or unspecified (8%); 85% were Jewish, and 60% had ≥10 years of oncology experience. Most respondents thought that contacting bereaved families was important(73%), and that it provided closure for staff (79%); 41% indicated that they contacted >50% of the families of their deceased patients. Contacting bereaved families was considered the responsibility of the physicians (90%), nurses (84%), or social workers (89%). The main barriers to contacting bereaved families were emotional overload (68%) and lack of time (63%); 60% indicated a need for additional communication tools for bereavement follow-up. In a multivariate analysis, profession (physician vs. nurse), primary workplace (outpatient setting vs. other), and self-defined religion were significant variables with respect to the perceived importance of contacting bereaved families and to actually contacting them. Other factors (e.g., age, gender) were non-significant. Conclusions: Perspectives regarding bereavement actions differ significantly across medical professions, work settings, and self-defined religions. Additional guidance and education regarding bereavement actions is warranted. © 2016 Granot et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Caglar H.B.,Brigham and Women's Hospital | Othus M.,Dana-Farber Cancer Institute | Allen A.M.,Brigham and Women's Hospital | Allen A.M.,Davidoff Center
Radiotherapy and Oncology | Year: 2010

Purpose: To define optimization parameters for limiting esophageal toxicity with concurrent chemoradiation (CRT) for non-small cell lung cancer (NSCLC). Materials and methods: A retrospective analysis of patients treated with concurrent chemoradiation at the Dana-Farber/Brigham and Women's Hospital Cancer Center was done with IRB approval. All patients were treated with concurrent CRT. All patients underwent 3-D conformal radiotherapy planned with ECLIPSE (Varian, Palo Alto, CA) treatment planning system. Patients had their esophagus contoured in two ways: the entire esophagus (Esoph) and esophagus in-field (Esophin). Together with clinical variables, dose volume metrics including mean dose, V5-V60 of both structures (Esoph and Esophin) were analyzed for correlation with acute esophagitis (≥grade 3) and late esophageal stricture. The analyses and graphics were completed using R (R Development Core Team, 2006). Logistic regression analysis was used to assess the relationships between dosimetric factors and swallowing complications while controlling for non-dosimetric variables. Results: 109 patients were studied between 2000 and 2006. 25% of patients had grade 3 or greater acute esophagitis. 5/109 (5.5%) had late esophageal stricture with a six-month actuarial risk of stricture of 6.5% (95% CI = 1-11%). Mean dose and V45-V60 for both Esoph and Esophin significantly correlated with development of acute esophagitis. V55 and V60 for both Esoph and Esophin significantly correlated with development of stricture. On Multivariate analysis V55 of the Esoph and Esophin was most predictive of toxicity. Limiting the V55 Esophin to 50% was the best cut-point for acute esophagitis. Conclusions: In the setting of concurrent CRT, V55 of the Esoph or Esoph in is the best predictor of acute esophagitis. © 2010 Elsevier Ireland Ltd. All rights reserved.


Wein S.,Davidoff Center
Journal of Pain and Palliative Care Pharmacotherapy | Year: 2012

Opioid-induced constipation is described, including features, mechanism, and management of the disorder. The role of various categories of laxatives including suppositories and the use of a peripherally acting μ-opioid receptor antagonist are discussed. Copyright © 2012 Informa Healthcare USA, Inc.


Shimoni A.,Chaim Sheba Medical Center | Avivi I.,Rambam Medical Center | Rowe J.M.,Rambam Medical Center | Yeshurun M.,Davidoff Center | And 6 more authors.
Cancer | Year: 2012

BACKGROUND: High-dose chemotherapy combined with autologous stem-cell transplantation (ASCT) is the standard therapy for refractory/relapsed aggressive lymphoma. In the era of rituximab-containing frontline regimens, it is becoming more challenging to salvage patients in this setting, and novel approaches are required. This is a randomized study evaluating the safety and efficacy of standard-dose ibritumomab tiuxetan (Zevalin) combined with high-dose BEAM chemotherapy (Z-BEAM) and ASCT in refractory/relapsed aggressive lymphoma. METHODS: Forty-Three patients with CD20+-aggressive lymphoma were randomized to a treatment arm (Z-BEAM, n = 22) or control arm (BEAM alone, n = 21). Ibritumomab tiuxetan was given at 0.4 mCi/kg on day -14 before ASCT. RESULTS: Patient characteristics, engraftment kinetics, and toxicity profile were similar between the 2 groups. Two-year progression-free survival (PFS) for all patients was 48% (95% confidence interval, 32%-64%): 59% and 37% after Z-BEAM and BEAM alone, respectively (P =.2). Multivariate analysis identified advanced age (hazard ratio [HR], 8.3; P =.001), high-risk disease (relapse within 12 months of diagnosis and/or secondary International Prognostic Index >2; HR, 2.8; P =.04), positive positron emission tomography-computed tomography pretransplant (HR, 2.4; P =.07), and BEAM alone (HR, 2.8; P =.03) as poor prognostic factors. Intermediate-risk patients with 1 or 2 risk factors had better PFS with Z-BEAM compared with BEAM: 69% and 29%, respectively (P =.07). Two-year overall survival was 91% and 62% after Z-BEAM and BEAM, respectively (P =.05). Similar prognostic factors determined survival. The HR for BEAM alone in the multivariate analysis was 8.1 (P =.01). CONCLUSIONS: Standard-dose ibritumomab tiuxetan combined with BEAM high-dose chemotherapy is safe and possibly more effective than BEAM alone as a conditioning regimen for ASCT in the era of rituximab-containing chemotherapy regimens. © 2012 American Cancer Society.


Wan D.,British Columbia Cancer Agency | Villa D.,British Columbia Cancer Agency | Woods R.,British Columbia Cancer Agency | Yerushalmi R.,British Columbia Cancer Agency | And 2 more authors.
Clinical Breast Cancer | Year: 2016

Background Breast cancer subtypes occur differentially across different racial and ethnic groups. However, their distribution within a multicultural population is unknown. Materials and Methods Patients with invasive breast cancer newly diagnosed in 2006 and referred to the British Columbia Cancer Agency were identified from the Breast Cancer Outcomes Unit database. Race/ethnicity data were abstracted from a patient-completed health assessment questionnaire completed at the initial consultation, and grouped as white, East Asian, Aboriginal, South Asian, Southeast Asian, and other. Breast cancer subtypes were created using available data on estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) status. Results A total of 1829 women had complete data. Of these women, 73% were white, 8% were East Asian, 4% Aboriginal, 3% South Asian, 3% Southeast Asian, and 3% other. The median age at diagnosis was 60 years; the youngest were Southeast Asian (51 years) and the oldest were white (60 years; P <.001). The overall ER positivity rate was 81%, highest in East Asian women (89%) and lowest in South Asian women (73%). The HER2 positivity rate was 16% for all patients and was highest in the South Asian (28%), Southeast Asian (28%), and Aboriginal (24%) women and lowest in the white women (14%; P <.001). Triple-negative (ER-, PR-, and HER2-negative) breast cancer was uncommon in East Asian women (5%) but more common in South Asian women (19%; P <.001). The 5-year breast cancer-specific survival was 90% (95% confidence interval, 89%-92%), with no significant difference among the racial/ethnic groups (P =.136). Conclusion Breast cancer subtypes varied by race/ethnicity in our cross-sectional cohort of a multicultural population, suggesting that race/ethnicity plays a significant role in the biology of invasive breast cancer. © 2015 Elsevier Inc.


Weissmann-Brenner A.,Helen Schneider Hospital for Women | Brenner B.,Davidoff Center | Sulkes J.,Epidemiology Unit | Kaplan B.,Helen Schneider Hospital for Women
Medical Science Monitor | Year: 2010

Background: Following the publication of the results of Women's Health Initiative in 2002 there have been gross changes in the attitude of women and physicians towards the risks and benefits of hormone replacement therapy (HRT). We evaluated the attitude of women gynecologist towards their own health, including adherence to recommended screening tests and self usage and prescription of hormone replacement therapy. Material/Methods: Questionnaires regarding performance of screening tests, self usage and recommendation of HRT were posted by mail to all Israel's women gynecologists. Results: Ninety questionnaires were eligible for analysis (43.2% response rate). Average age was 48±7.7 years. Only 7/90 (7.8%) gynecologists smoke regularly and average body mass index was 25±3.8 kg/m2. Most participants performed at least one screening tests in the past 2 years. The median interval from the last self breast exam, mammography, gynecologisy exam, Papanicolaou test, colonoscopy and bone density test was 0.2, 1.82, 1.79, 1.95, 3.27 and 1.41 years, respectively. Most of them (68.3%) did not routinely recommend HRT to their patients. The duration of self HRT usage ranged between 1-20 years (average 5.1±3.4 years). Most gynecologists (87.7%) recommended continuous estrogen and progesterone for women with their uterus in place. Conclusions: The health profile of Israeli women gynecologists is chracterized by a high performance of screening tests for cancer and low rate of smoking. Our study also demonstrates that the impact of the results of the WHI trial is still well manifested and most Israeli women gynecologists do not routinely recommend HRT to postmenopausal women. © Med Sci Monit, 2010.


PubMed | Center of Oncology of Poland, Cancer Institute Ion Chiricuta, St Elisabeth Cancer Institute, University of Szeged and 13 more.
Type: Clinical Trial, Phase III | Journal: British journal of cancer | Year: 2014

The randomised phase III TURANDOT trial compared first-line bevacizumab-paclitaxel (BEV-PAC) vs bevacizumab-capecitabine (BEV-CAP) in HER2-negative locally recurrent/metastatic breast cancer (LR/mBC). The interim analysis revealed no difference in overall survival (OS; primary end point) between treatment arms; however, progression-free survival (PFS) and objective response rate were significantly superior with BEV-PAC. We sought to identify patient populations that may be most appropriately treated with one or other regimen.Patients with HER2-negative LR/mBC who had received no prior chemotherapy for advanced disease were randomised to either BEV-PAC (bevacizumab 10 mg kg(-1) days 1 and 15 plus paclitaxel 90 mg m(-2) days 1, 8 and 15 q4w) or BEV-CAP (bevacizumab 15 mg kg(-1) day 1 plus capecitabine 1000 mg m(-2) bid days 1-14 q3w). The study population was categorised into three cohorts: triple-negative breast cancer (TNBC), high-risk hormone receptor-positive (HR+) and low-risk HR+. High- and low-risk HR+ were defined, respectively, as having 2 vs 1 of the following four risk factors: disease-free interval 24 months; visceral metastases; prior (neo)adjuvant anthracycline and/or taxane; and metastases in 3 organs.The treatment effect on OS differed between cohorts. Non-significant OS trends favoured BEV-PAC in the TNBC cohort and BEV-CAP in the low-risk HR+ cohort. In all three cohorts, there was a non-significant PFS trend favouring BEV-PAC. Grade 3 adverse events were consistently less common with BEV-CAP.A simple risk factor index may help in selecting bevacizumab-containing regimens, balancing outcome, safety profile and patient preference. Final OS results are expected in 2015 (ClinicalTrials.gov NCT00600340).


PubMed | Herzog Hospital, Hebrew University of Jerusalem, Ariel University, Tel Aviv University and Davidoff Center
Type: Journal Article | Journal: Integrative cancer therapies | Year: 2016

Purpose To evaluate the long-term effect of group intervention on enhancing cognitive emotion regulation (CER) strategies in female patients with early-stage breast cancer. Methods The sample included 174 patients who were diagnosed with early-to-mid stage breast cancer, completed adjuvant therapy, and agreed to fill out demographic and cognitive emotion regulation questionnaires (CERQ). About half of the patients (86, 49.4%) chose to participate in an 8-session group intervention (intervention group) while the others (88, 50.6%) did not (comparison group). The structured intervention for enhancing coping strategies with special emphasis on emotion regulation was conducted at the oncology unit at Rabin Medical Center by 2 experienced therapists. Preliminary effects on CER evaluated 6, 12, and 24 months postintervention were compared to the CER of a group of patients that opted not to participate in the group intervention. Results In the intervention group, the long-term effect (from baseline to 24 months) was assessed using the mix models module. Significant interaction effects were found for both the Negative CER scales (F(3, 268 ,404) = 3.66, P = .01) and for the Positive CER scales (F(3, 271 ,660) = 5.12, P = .002). No statistically significant differences in socio-demographic characteristics and medical variables were observed between the intervention and comparison groups. Conclusion Our findings indicate that a group intervention aimed at empowerment of coping strategies had positive long-term outcomes that reinforce adaptive coping strategies and improve less effective strategies of cognitive emotion regulation.


PubMed | Tel Aviv Sourasky Medical Center, University of Szeged, University of Sarajevo, National Institute of Oncology and 5 more.
Type: Clinical Trial, Phase III | Journal: British journal of cancer | Year: 2016

Correlations between development of hand-foot syndrome (HFS) and efficacy in patients receiving capecitabine (CAP)-containing therapy are reported in the literature. We explored the relationship between HFS and efficacy in patients receiving CAP plus bevacizumab (BEV) in the TURANDOT randomised phase III trial.Patients with HER2-negative locally recurrent/metastatic breast cancer (LR/mBC) who had received no prior chemotherapy for LR/mBC were randomised to BEV plus paclitaxel or BEV-CAP until disease progression or unacceptable toxicity. This analysis included patients randomised to BEV-CAP who received 1 CAP dose. Potential associations between HFS and both overall survival (OS; primary end point) and progression-free survival (PFS; secondary end point) were explored using Cox proportional hazards analyses with HFS as a time-dependent covariate (to avoid overestimating the effect of HFS on efficacy). Landmark analyses were also performed.Among 277 patients treated with BEV-CAP, 154 (56%) developed HFS. In multivariate analyses, risk of progression or death was reduced by 44% after the occurrence of HFS; risk of death was reduced by 56%. The magnitude of effect on OS increased with increasing HFS grade. In patients developing HFS within the first 3 months, median PFS from the 3-month landmark was 10.0 months vs 6.2 months in patients without HFS. Two-year OS rates were 63% and 44%, respectively.This exploratory analysis indicates that HFS occurrence is a strong predictor of prolonged PFS and OS in patients receiving BEV-CAP for LR/mBC. Early appearance of HFS may help motivate patients to continue therapy.


Perceptions of the role of oncology medical staff in supporting bereaved families have evolved with the transition to interdisciplinary cancer care. We investigated the interactions between oncology professionals and bereaved families.This cross-sectional study involved all oncology medical staff at the Davidoff Center. Participants were given a questionnaire relating to bereavement follow-up. Responses were measured using a 5-point Likert scale.Of 155 staff members, 107 filled questionnaires with <20% missing data and were included in the analysis ( = 0.799; corrected, = 0.821). Respondents included physicians (35%), nurses (46%), social workers (7%), psychologists (4%), or unspecified (8%); 85% were Jewish, and 60% had 10 years of oncology experience. Most respondents thought that contacting bereaved families was important (73%), and that it provided closure for staff (79%); 41% indicated that they contacted >50% of the families of their deceased patients. Contacting bereaved families was considered the responsibility of the physicians (90%), nurses (84%), or social workers (89%). The main barriers to contacting bereaved families were emotional overload (68%) and lack of time (63%); 60% indicated a need for additional communication tools for bereavement follow-up. In a multivariate analysis, profession (physician vs. nurse), primary workplace (outpatient setting vs. other), and self-defined religion were significant variables with respect to the perceived importance of contacting bereaved families and to actually contacting them. Other factors (e.g., age, gender) were non-significant.Perspectives regarding bereavement actions differ significantly across medical professions, work settings, and self-defined religions. Additional guidance and education regarding bereavement actions is warranted.

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