Background: Most of patient with Biliary Tract Cancer (BTC) has not access to surgery because of Advanced/metastatic disease at diagnosis (aBTC). They receive palliative chemotherapy and/or Palliative Care (PC). We studied if early palliative care referral might influence Overall Survival (OS) and the aggressiveness of end-of-life care.

Participants: We conducted a retrospective multicentric cohort study in patients with non-curative BTC, diagnosed between 2013 and 2019 in 6 hospitals of Eastern France. PC was defined a specialist-delivered palliative care encounter.

Results: 200 patients with aBTC were included. 87 (44%) never received PC, 30 (15%) had very early PC (<3 months after aBTC diagnosis), 20 (10%) had an early PC (3-6 months), and 63 (32%) had late PC (>6 months). The median time between referral and death was 0.9 to 1.3 months. OS were 12.4 months (no PC), 3.0 months (PC<3 m), 6.4 months (PC 3-6 m), 16 months (PC>6 m). There was no evidence for survival improvement with early PC. PC tended to reduce chemotherapy near death (37% without PC, 30% with PC<3m, 11% with PC 3-6m, 10% with PC>6m), visits in emergency department (ED) during final month (respectively: 36%, 20 %, 15%, and 7%), intensive care unit hospitalizations (ICU) near death (13%, 0%, 0%, 2%). Place of death seemed to be positively impacted by PC (conventional acute unit, respectively: 73%, 21%, 21%, 25% and ICU or ED: 8%, 0%, 5%, 2%).

Conclusion: Referral to PC remains too late in the support of patients with aBTC. Our practice should evolve: all patients with aBTC should be referred to early PC in palliative care unit after diagnosis to improve the management of end-of-life, symptoms, and family needs.

Purpose: The purpose of this study was to analyse the clinical management and Quality of Life (QoL) of frail patients with cancer, chronic background pain and Breakthrough Cancer Pain (BTcP) and to assess whether treatment was conditioned by their frailty status.

Methods: This was an observational study in adult frail patients with cancer, chronic background pain and BTcP. Outcomes of interest collected include clinical and sociodemographic data, Karnofsky Performance Status, quality of life (EuroQoL-5D-5L), chronic pain and BTcP characteristics, as well as treatments administered for their control.

Results: A total of 222 patients were included with a mean age of 68 years (range 24-91), 60.5% men, with a mean Karnofsky of 63.2%. The number of daily episodes of BTcP was 3.8 (95% CI 3.3-4.3), with a duration of 34.6 minutes (95% CI 28.8-40.3), and 56.8% had a gradual onset. Opioids were administered to 88.3% of patients for the chronic pain, and to 83.8% for BTcP. The treatment's daily doses administered for chronic pain and BTcP did not differ from those usually recommended. QoL was significantly worst in frail patients with cancer than EuroQol-5D-5L healthy age-matched no frail patients and was related to performance status (p<0.001) and to the social-familial status (p=0.045).

Conclusion: BTP in frail patients with cancer presents with more episodes, of a shorter duration and more gradual onset compared to other published references of patients with BTcP. QoL was seriously affected in this group of patients. No relevant differences were seen in the doses or method of administration of treatments for chronic pain and BTP in frail patients with cancer as compared to the standard recommendations for non-frail patients. Our findings support the importance of the frailty assessment in all patients with BTcP.

Objective: The aim of the study was to determine the nationwide prevalence, trends, and predictors of inpatient PCa screening in average risk patients using the National Inpatient Sample (NIS) database.

Methods: NIS records from 2006 to 2014 were used to evaluate inpatient PCa screening encounters across United States (US) hospitals. All male patients between the ages of 45 and 69 at average risk for PCa were included. The outcome was whether a patient had an encounter for PCa as noted on their discharge record. Variables analyzed included demographic factors, hospital characteristics, and other concomitant diagnoses for prostatic or urologic problems.

Results: The prevalence of inpatient PCa screening was 2.57 per 100,000 hospital discharges. In a multivariate setting, the following were significant factors associated with greater odds of inpatient screening: Medicare (AOR: 3.07; P=0.0016), self-pay or uninsured patients (AOR: 1.74; P=0.0371), rural (AOR: 11.9; P ≤ 0.0001) or urban nonteaching hospitals (AOR: 5.26; P ≤ 0.0001), Midwest hospitals (AOR: 4.90; P ≤ 0.0001), urinary tract infection (P=0.0367), genitourinary symptoms (P<0.0001), prostatic hyperplasia (P=0.0006), or other male genital disorder diagnoses (P<0.0001).

Conclusion: In light of unequal access to healthcare, disparities exist in uninsured and rural populations regarding cancer screening. PSA is a minimally invasive test that can help screen individuals at increased risk for the development of prostate cancer, allowing for early detection, prevention, improved rates of cure and ultimately, decreased rates of mortality.

Standard of care and protocols for the treatment of pediatric cancer lead to a clear improvement in survival rates and quality of life. Little is known about how these treatments are implemented in Brazil. Our study aimed to evaluate children treated for Hodgkin Disease (HD) in south Brazil between 2002 and 2013 through the analysis of medical records in 6 different centers.

Fifty-nine children and adolescents were included. The median age was 12 years (range 3-18 years). Male:Female ratio was 1.95:1. Localized disease (stage I/II) was observed in 30 patients (50.8%) while the remaining 29 (49.2%) had advanced disease (Stage III/IV).

The chemotherapeutic treatment schema was different among services and comprised three different based protocols. ABVD schema was the most frequently used (52 children (88.1%). The number of cycles was highly variable (4-16 cycles) even at the same clinical stage and with similar clinical response.

These data highlight the importance of turning the “best practice policies” readily available to all pediatric oncologists. Local protocols allow integrative studies among centers that would certainly maintain or improve cure rates, reduce long-term toxicity and evaluate specific biological characteristics of these diseases in our population.

Introduction: Metastatic Merkel Cell Carcinoma (MCC) is characterized by poor prognosis and poor response to cytotoxic chemotherapy. Immune Checkpoint Inhibitors (ICIs) were evaluated in several clinical trials, providing interesting results in terms of activity and efficacy, with a generally manageable safety profile. Limited data are available for use of ICIs in patients affected by multiple chronic diseases. We present the case of a patient with several comorbidities treated with Avelumab for advanced MCC, who developed a durable complete response.

Case description: A 78-year-old woman with several chronic diseases was treated with Avelumab for MCC with lung and subcutaneous metastases, developing radiological complete response after 5 cycles. Treatment was well tolerated and no severe adverse events were observed.

Conclusion: Our case shows that Avelumab is an active and safe treatment in multimorbid patients with advanced MCC. More consistent data from randomized clinical trials are needed to confirm these results in a large patient population presenting these special features.

Introduction: Survival in patients with Hepatocellular Carcinoma (HCC) has been previously found to be worse with increase in tumor size, but also with increase in inflammation. To examine these issues separately, we aimed to study the influences on survival of various liver inflammation parameters in the whole cohort, and separately in patients with HCCs of defined Maximum Tumor Diameter (MTD).

Methods: A prospectively collected large database of Turkish HCC patients with documented survival was interrogated. Patients had baseline liver function tests and CT scans for tumor characteristics. Liver function and inflammation parameters included blood tests for levels of albumin, AST, GGT, ALKP, CRP, ESR and WBC.

Results: Survival was worse for patients with larger HCCs, including those with low or high serum AFP levels. Highest hazard ratios were found for patients with abnormal blood albumin (low) or AST (high) levels, regardless of AFP status. When patients were separately examined according to tumor size, only albumin and AST were significant for survival in patients with small <3cm tumors; whereas albumin, AST and ALKP were significant in patients with >3cm HCCs. Abnormal albumin or AST levels in different HCC size cohorts significantly related to percent patients with PVT, higher AFP or increased tumor focality, regardless of tumor size.

Results: Survival was worse for patients with larger HCCs, including those with low or high serum AFP levels. Highest hazard ratios were found for patients with abnormal blood albumin (low) or AST (high) levels, regardless of AFP status. When patients were separately examined according to tumor size, only albumin and AST were significant for survival in patients with small <3cm tumors; whereas albumin, AST and ALKP were significant in patients with >3cm HCCs. Abnormal albumin or AST levels in different HCC size cohorts significantly related to percent patients with PVT, higher AFP or increased tumor focality, regardless of tumor size.