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The University of Texas MD Anderson Cancer Center, a comprehensive cancer center designated by the National Cancer Institute (NCI), defines its service population area as the State of Texas (29.1 M), the second most populous state in the country and the state with the greatest number of uninsured residents in the United States. Consistent with a novel and formal commitment to prevention as part of its core mission, alongside clear opportunities in Texas to drive vaccine uptake, MD Anderson assembled a transdisciplinary team to develop an institutional Framework to increase adolescent HPV vaccination and reduce HPV-related cancer burden. The Framework was developed and activated through a four-phase approach aligned with the NCI Cancer Center Support Grant Community Outreach and Engagement component. MD Anderson identified collaborators through data-driven outreach and constructed a portfolio of collaborative multi-sector initiatives through review processes designed to assess readiness, impact and sustainability. The result is an implementation community of 78 institutions collaboratively implementing 12 initiatives within a shared measurement framework impacting 18 counties. This paper describes a structured and rigorous process to set up the implementation of a multi-year investment in evidence-based strategies to increase HPV vaccination that solves challenges preventing implementation of recommended strategies and to encourage similar initiative replication.

Infection of SARS-CoV-2 among health workers (HWs) in contact with cancer patients has been a major issue since the beginning of the pandemic. We aimed to assess the serological immune status of SARS-CoV-2 infection among these HWs. A prospective cohort study was initiated in the comprehensive cancer center of the Nouvelle-Aquitaine region (NA, France). Volunteer HWs working on March 2020 without active infection or symptoms of COVID-19 completed a self-questionnaire and had a blood test at inclusion, at 3 and 12 months. Positive serological status of SARS-CoV-2 infection was defined by anti-nucleocapsid antibodies and/or IgG anti-spike antibodies, except at 12 months due to vaccine. Half of the HWs were included (N = 517) and 89% were followed for three months (N = 500) and one year (N = 462). Seroprevalence of SARS-CoV-2 infection was 3.5% (95% CI: 1.9–5.1), 6.2% (95% CI: 4.1–8.3), and 10% (95% CI: 7.2–12.7) on June–September 2020, September 2020–January 2021, and June–October 2021, respectively. At 12 months, 93.3% had detectable antibodies with 80% vaccinated in the first three months of vaccine availability. The COVID-19-free policy of the institution, respect for barrier gestures, high and early vaccination of HWs, and low prevalence of SARS-CoV-2 in NA may explain the low rate of seropositivity among the HWs of the Institut Bergonié.

While cancer mortality is declining in the United States, significant racial, ethnic, economic and geographic inequities persist. To help address inequities in cancer treatment, care, support and research, the National Cancer Institute (NCI) instituted the community outreach and engagement (COE) mandate for NCI-designated comprehensive cancer centers (CCCs). The Bristol Myers Squibb Foundation designed a convening and listening session on COE with NCI leaders and staff gathering representatives from CCCs and the broader cancer community. This paper captures recommendations from the listening session for the NCI and CCCs to further evolve the implementation and impact of the COE mandate on cancer control and outcomes.

がんセンターでは，外来化学療法，放射線治療，緩和ケアチーム診療の他，相談支援，がん登録の業務を実施している．本文では各部署の活動と実績を報告する．化学療法センターでは化学療法により在宅診療を継続する．放射線治療では限局期がんは根治をめざし，進行期がんは症状緩和を行う．緩和ケアチームはがん症状の緩和を目的として活動する．がん相談支援センターではがん患者の療養についての相談に対応する．歯科チームは化学療法や放射線治療の前後で口腔ケアを実施する．がん看護師チームは告知後の患者へカウンセリングを担当し，薬剤部スタッフは化学療法の説明とミキシングを実施する．がん登録は当院で治療したがん症例を登録し，岡山県と厚生労働省へ報告する．がんセンターは，今後とも各診療科と連携して質の高いがん医療と患者支援を提供できるよう努めていく．

Highlights • Risk of distress/burnout amongst oncology professionals continues to worsen since COVID-19 despite improved job performance. • Female and younger (≤40 years old) colleagues continue to be at higher risk of poor well-being and feeling burnout. • Job demands have increased, with nearly half now feeling overwhelmed with workload. • Concerns regarding career development/training, job security, and international fellowship opportunities remain high. • A quarter of oncology professionals reported considering changing their career, including leaving the oncology profession. Background COVID-19 has had a significant impact on the well-being and job performance of oncology professionals globally. The European Society for Medical Oncology (ESMO) Resilience Task Force collaboration set out to investigate and monitor well-being since COVID-19 in relation to work, lifestyle and support factors in oncology professionals 1 year on since the start of the pandemic. Methods An online, anonymous survey was conducted in February/March 2021 (Survey III). Key outcome variables included risk of poor well-being or distress (expanded Well-Being Index), feeling burnout (single item from expanded Well-Being Index), and job performance since COVID-19. Longitudinal analysis of responses to the series of three surveys since COVID-19 was carried out, and responses to job demands and resources questions were interrogated. SPSS V.26.0/V.27.0 and GraphPad Prism V9.0 were used for statistical analyses. Results Responses from 1269 participants from 104 countries were analysed in Survey III: 55% (n = 699/1269) female, 54% (n = 686/1269) >40 years, and 69% (n = 852/1230) of white ethnicity. There continues to be an increased risk of poor well-being or distress (n = 464/1169, 40%) and feeling burnout (n = 660/1169, 57%) compared with Survey I (25% and 38% respectively, P < 0.0001), despite improved job performance. Compared with the initial period of the pandemic, more participants report feeling overwhelmed with workload (45% versus 29%, P < 0.0001). There remain concerns about the negative impact of the pandemic on career development/training (43%), job security (37%). and international fellowship opportunities (76%). Alarmingly, 25% (n = 266/1086) are considering changing their future career with 38% (n = 100/266) contemplating leaving the profession. Conclusion Oncology professionals continue to face increased job demands. There is now significant concern regarding potential attrition in the oncology workforce. National and international stakeholders must act immediately and work closely with oncology professionals to draw up future-proof recovery plans.

Objective: To identify the biodiversity of Nocardia species isolated from the environments of Tehran hospitals via phenotypic and PCR molecular methods. Methods: A total of 236 samples were collected from the transplantation and cancer centers of five Tehran hospitals, and the presence of Nocardia was identified by using standard protocols. Conventional tests were used for preliminary identification, and PCR amplification of the 598 bp amplicon of the 16S rRNA and sequence analysis of 16S rRNA were performed for genus and species identification. Results: From the 236 soil samples, 16 samples were identified as positive based on the culture tests, while 8 samples showed positive results based on the molecular method. The phylogenetic tree showed that the most frequent genus of Nocardia was related to Nocardia cyriacigeorgica. Conclusion: The hospital environment is a potential reservoir of a diverse range of Nocardia species. Due to the strong capability of survival, these bacteria bring a threat to the health of patients. Its identification can help physicians to implement treatments and is important for healthcare centers.

Health-care workers (HCW) are at high risk for SARS-CoV-2 infection and, if asymptomatic, for transmitting the virus to fragile cancer patients. We monitored all asymptomatic HCWs of a cancer institute (94% of all employees agreed to enter the study) with the rapid serological test, VivaDiagTM, identifying SARS-CoV-2 associated-IgM/IgG. The tests were performed at time 0 (n = 606) and after 14 days (n = 393). Overall, the VivaDiagTM results of nine HCWs (1.5%) were positive, with one confirmed to be SARS-CoV-2-positive after oropharyngeal swab testing by RT-PCR. At time 0, all nine cases showed IgM expression while IgG was detected in only one. After 14 days, IgM persisted in all the cases, while IgG became evident in four. A chemiluminescence immunoassay (CLIA) confirmed IgM positivity in 5/13 VivaDiagTM positive cases and IgG positivity in 4/5 VivaDiagTM positive cases. Our study suggests that the VivaDiagTM test can be of help in identifying SARS-CoV-2 infected people in cohorts of subjects with a high prevalence.

Background In view of the potential gravity of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection for patients with cancer, epidemiological data are vital to assess virus circulation among patients and staff of cancer centres. We performed a prospective study to investigate seroprevalence of SARS-CoV-2 antibodies among staff and patients with cancer at a large cancer centre, at the end of the period of first national lockdown in France and to determine factors associated with the risk of SARS-CoV-2 infection. Methods After the first lockdown, all medical and non-medical staff, as well as all patients attending the medical oncology department were invited to undergo serological testing for SARS-CoV-2 between 11 May and 30 June 2020. All participants were also invited to complete a questionnaire collecting data about their living and working conditions, and for patients, medical management during lockdown. Findings A total of 1,674 subjects (663 staff members, 1011 patients) were included. Seroprevalence was low in both staff (1.8%) and patients (1.7%), despite more features of high risk for severe forms among patients. None of the risk factors tested in our analysis (working or living conditions, comorbidities, management characteristics during lockdown) was found to be statistically associated with seroprevalence in either staff or patients. There was no significant difference in the proportion of symptomatic and asymptomatic subjects between staff and patients. Only fever, loss of smell, and loss of taste were significantly more frequent among seropositive patients, in both staff and patients. Interpretation We report very low seroprevalence of antibodies against SARS-CoV-2 in the staff (caregiving and non-caregiving) and patients of a large cancer care centre in which strict hygiene, personal protection, and social distancing measures were implemented.

In recent years, the cancer research and care community has been more attuned to health equity, increasingly pursuing coordinated and comprehensive action to achieve equitable health outcomes. In addition to its support of a joint research agenda for health disparities in 2017, the National Cancer Institute (NCI) has demonstrated its commitment to addressing health inequities with its 2012 requirement for cancer centers to define and address the needs of a local "catchment area" and the 2016 mandate for Community Outreach and Engagement (COE). With several years of experience with the COE requirements, there is an opportunity to reflect on the experience to-date and identify opportunities to bolster the impact of COE on equitable cancer outcomes for the future. To do so, the Bristol Myers Squibb Foundation (BMSF) hosted a special convening and listening session in April 2019. The session agenda was cocreated by BMSF and NCI leaders and staff. It brought together 41 individuals, including representatives from the NCI Cancer Centers Program, Division of Cancer Control and Population Health and Center to Reduce Cancer Health Disparities, 22 NCI-designated, emerging or affiliated comprehensive cancer centers, and the broader cancer community. This article captures key themes from that meeting, including an overview of current COE efforts, with a deeper look at how four cancer centers are embedding health equity and COE efforts into their institutions and work, and the successes and challenges they have encountered.

Background: Cancer incidence and mortality is increasing worldwide. In 2018, there were an estimated 18.1 million new cancer cases and 9.6 million cancer deaths. In Nigeria, it is estimated that 100,000 new cases occur annually, with a high case fatality ratio. The burden of cancer in Nigeria is significant, as the country still grapples with infectious diseases and has limited data on cancer epidemiology. Our study is descriptive using data from a hospital-based registry. Objectives: This retrospective study assesses the characteristics of patients that presented to a private cancer center in Lagos, Nigeria. We aimed to update knowledge on the current trends of cancer in Nigeria as exemplified by the experience of this cancer center and set a foundation for guiding future research and policy efforts in cancer screening, prevention, and control. Methods: The records of all the 548 oncology patients registered at the Lakeshore Cancer Center (LCC) cancer registry from January 2015 to June 2018 were reviewed for this study. Results: Most common cancer types were breast cancer for females (46%) and prostate cancer for males (32%). 92% of the tumors were malignant and 97% of the patients were symptomatic. Among patients diagnosed with cancer, 49% were ≤ 50 years old, 90% paid for their healthcare out of pocket, and 67% did not complete treatment.Conclusions: This study highlights the state of cancer care in Nigeria and should guide future research, with a focus on public awareness, screening programs and implementation of novel cancer control policies and infrastructure that supports early detection.

COVID-19 pandemic following the outbreak in China and Western Europe, where it finally lost the momentum, is now devastating North and South America. It has not been identified the reason and the molecular mechanisms of the two different patterns of the pulmonary host responses to the virus from a minimal disease in young subjects to a severe distress syndrome (ARDS) in older subjects, particularly those with previous chronic diseases (including diabetes) and cancer. The Management of the Istituto Nazionale Tumori - IRCCS “Fondazione Pascale” in Naples (INT-Pascale), along with all Health professionals decided not to interrupt the treatment of those hospitalized and to continue, even if after a careful triage in order not to allow SARS-CoV-2 positive subjects to access, to take care of cancer patients with serious conditions. Although very few (n = 3) patients developed a symptomatic COVID-19 and required the transfer to a COVID-19 area of the Institute, no patients died during the hospitalization and completed their oncology treatment. Besides monitoring of the patients, all employees of the Institute (physicians, nurses, researchers, lawyers, accountants, gatekeepers, guardians, janitors) have been tested for a possible exposure. Personnel identified as positive, has been promptly subjected to home quarantine and subdued to health surveillance. One severe case of respiratory distress has been reported in a positive employees and one death of a family member. Further steps to home monitoring of COVID-19 clinical course have been taken with the development of remote Wi-Fi connected digital devices for the detection of early signs of respiratory distress, including heart rate and oxygen saturation.In conclusion cancer care has been performed and continued safely also during COVID-19 pandemic and further remote home strategies are in progress to ensure the appropriate monitoring of cancer patients.

Objectives This study aimed to evaluate diagnostic performance in characterising ovarian masses by our gynaecological oncology multidisciplinary team meeting (MDM). Surgical outcome and overall impact on patients and healthcare service were also assessed. Methods This was a prospective cohort study of all women with adnexal masses presenting to the gynaecological oncology MDM at a central London tertiary cancer centre between February 2017 and February 2018. The multidisciplinary team (MDT) outcome, imaging details, subjective opinion, tumour markers, surgical details, and final histological diagnosis were collected. Diagnostic performance was also determined. Results There were 200 eligible patients in the study period. MDM imaging review demonstrated a sensitivity of 98.4% (95% CI: 94.3% to 99.8%) and a specificity of 52% (95% CI: 40.2% to 63.7%). Thirty-five cases were false positive, either presumed invasive cancers (51%) or borderline tumours (49%). The most common histological types were serous (37%) and mucinous (31%) cystadenomas. A retrospective application of the International Ovarian Tumor Analysis (IOTA) Assessment of Different NEoplasias in the adneXa (ADNEX) model suggests a potential reduction in false-positive rates (17%). Among the false-positive cases, there was no postoperative (90 days) mortality and postoperative morbidity was 14% with only grade 2 (CD2) complications according to Clavien and Dindo's CD classification. Conclusion An MDT has high sensitivity but low specificity when characterising ovarian masses referred with possible ovarian cancer to the tertiary centre. False-positive values in ovarian cancers are an important indicator of over-treatment. More research is required to assess other methods, such as the IOTA ADNEX model, to reduce the false-positive value.

Cutaneous metastasis (CM) occurs infrequently and usually presents during the later stages of cancer, and has a poor prognosis. Although there are insufficient current data, cancer treatment changes could have a positive impact on the outcome. This retrospective study aimed to review the pattern and prognosis of CM in patients with solid malignancy in a tertiary cancer center in Thailand. We reviewed the medical records of cancer patients diagnosed with CM between October 2009 and August 2015 at Chulabhorn Hospital, a tertiary cancer center in Thailand. Patients with primary skin cancer and hematological malignancies were excluded. We collected and analyzed data, including the time of cancer diagnosis and CM, type of cancer, clinical characteristics, and survival outcome. Of 11,418 patients, there were 33 (0.3%) were diagnosed with CM. Breast cancer was the most common primary cancer (12 cases, 36%). Skin nodules were commonly detected on the anterior chest wall. Also, 79% of CM patients had concomitant visceral metastasis. The median overall survival of those with CM was 9.21 months (95% confidence interval 4.75–83.38 months) regardless of presentation either at onset or disease recurrence (P = .083). However, the change of management was affected in 78% diagnosed with a later stage of CM. No statistical difference in survival was observed between breast cancer and non-breast cancer patients (8.79 vs 9.21 months, P = .613). Despite CM being a sign of poor prognosis, it may still be an indicator for changing cancer patients’ treatment. Hence, early CM diagnosis and prompt novel therapy may positively affect outcomes for cancer patients.

Introduction: The novel Coronavirus disease 2019 pandemic is sweeping through China, posing the greatest ever threat to its public health and economy. As a tertiary cancer center in Southwest China, we formulated and implemented an anti-infection protocol to prevent the spread of Coronavirus disease 2019 in our department. Methods: The anti-infection protocol divided patients into 3 categories, namely outpatients, inpatients, and patients receiving radiation therapy at our cancer center, and each category had a distinct anti-infection protocol to minimize the risk of Coronavirus disease 2019 transmission. In each category, the patients were classified into high-, intermediate-, and low-risk groups. Each risk group was managed differently. A survey of patient volume changes prior to and during the Coronavirus disease 2019 outbreak was performed. Results: We carried out the anti-infection protocol at our cancer center during the Coronavirus disease 2019 outbreak. We found that the total volume of both outpatient visits and inpatient treatment declined significantly depending on the conditions of each group. Radiation therapy and palliative service had the lowest and highest volume reductions at 58.3% and 100%, respectively. The decline in outpatient volumes was higher than the decline in inpatient treatment services (78.8% vs 71.8%). There was no Coronavirus disease 2019 cross-infection at our center, or Coronavirus disease 2019–related injury or death. The anti-infection protocol measures continue to be taken at the hospital even today but they have been modified depending on the prevalent local conditions. Conclusions: Challenges from the Coronavirus disease 2019 pandemic remain in our community. The anti-infection protocol implemented at our cancer center has been effective in preventing cross-infection. Whether our anti-infection protocol experience can be applied to curb the spread of the infection in other parts of the world remains to be tested.

Objectives This study aims to evaluate the knowledge of healthcare providers and the cost of the current institutional e-resources in an adult oncology setting. To assess the awareness, accessibility, and utilization of the available intranet e-resources, a survey questionnaire was distributed to all oncology healthcare practitioners (physicians, nurses, and pharmacists) in an adult oncology center. The e-resources were divided into two main categories: pre-paid and institution-specific. The cost of the pre-paid e-resources was obtained from the relevant department. The cost of the institution-specific e-resources was calculated based on the human cost spent developing these e-resources; the cost of the information technology (IT) and the organizational overhead were also taken into consideration. Results Institution-specific e-resources constituted the majority (62%) versus (38%) for pre-paid. The overall awareness, access, and frequent utilization of institution-specific e-resources, as compared to pre-paid e-resources, were low (

Background The purpose of this study was to analyze the effect of fractionation schedule on local control in postoperative radiotherapy (RT) for sinonasal malignant melanoma. Methods Sixty-three patients who were treated with surgery and postoperative RT in 4 accredited head and neck cancer centers in the Netherlands between 1998 and 2013 were retrospectively studied. Outcomes with conventional fractionation (2-2.4 Gy per fraction; n = 27) were compared to hypofractionation (4-6 Gy per fraction; n = 36). The primary endpoint was local control and the secondary endpoint was toxicity. Results Comparable local control rates were found after 2 and 5 years (63% vs 64% and 47% vs 53%; P = .73 for, respectively, conventional fractionation vs hypofractionation). Local recurrences were predominantly present ipsilateral (92%) and within the irradiated volume (88%). Late toxicity grade ≥ 3 was observed in 2 of 63 patients, 1 patient in both groups. Conclusion Radiotherapy fractionation schedule did not influence the local control rate or the incidence of late toxicity in patients treated with surgery and RT for sinonasal malignant melanoma in this retrospective analysis. Due to this retrospective nature and the limited number of patients, strong recommendations cannot be made. Expected toxicity, patient convenience, and workload may be taken into account for the choice of fractionation schedule until conclusive evidence becomes available.

Impact of treatment site on disparities in outcome among adolescent and young adults with Hodgkin lymphoma

Tobacco cessation after cancer diagnosis leads to better patient outcomes. However, tobacco treatment services are frequently unavailable in cancer care settings, and multilevel implementation challenges can impede uptake of new programs. The National Cancer Institute (NCI) dedicated Cancer Moonshot funding through the Cancer Center Cessation Initiative (C3I) for NCI-Designated Cancer Centers to implement or enhance the implementation of tobacco treatment services. We examined a pragmatic application of the RE-AIM framework (reach, effectiveness, adoption, implementation, and maintenance) to evaluate tobacco treatment programs implemented within Cancer Centers funded through C3I. Using three C3I-funded Centers as examples, we describe how each RE-AIM construct was operationalized to evaluate the implementation of a wide range of cessation services (e.g., tobacco use screening, counseling, Quitline referral, pharmacotherapy) in this heterogeneous group of cancer care settings. We discuss the practical challenges encountered in assessing RE-AIM constructs in real world situations, including using the electronic health record (EHR) to aid in assessment. Reach and effectiveness evaluation required that Centers define the setting(s) where cessation services were implemented (to determine the "denominator"), enumerate the patient population, report current patient tobacco use, patient engagement in tobacco treatment, and 6-month cessation outcomes. To reduce site heterogeneity, increase data accuracy, and reduce burden, reach was frequently captured via standardized EHR enhancements that improved the identification of current smokers and tobacco treatment referrals. Effectiveness was determined by cessation outcomes (30-day point prevalence abstinence at 6-months post-engagement) assessed through a variety of data collection approaches. Adoption was measured by the characteristics and proportion of targeted cancer care settings and clinicians engaged in cessation service delivery. Implementation was assessed by examining the delivery of tobacco screening assessments and intervention components across sites, and provider-level implementation consistency. Maintenance assessments identified whether tobacco treatment services continued in the setting after implementation and documented the sustainability plan and organizational commitment to continued delivery. In sum, this paper demonstrates a pragmatic approach to using RE-AIM as an evaluation framework that yields relevant outcomes on common implementation metrics across widely differing tobacco treatment approaches and settings.

Актуальность. Организация отделения ультразвуковой диагностики онкологического диспансера изучена недостаточно. В литературе нет полноценной информации о факторах, влияющих на показатели деятельности этого подразделения, критериях, позволяющих прогнозировать и планировать его работу. Цель работы – выявить статистически достоверные факторы, определяющие показатели деятельности отделений ультразвуковой диагностики онкологического диспансера. Методы проведения работы. Проведён корреляционный анализ отчётов формы No30 Воронежского, Липецкого и Курского онкологических диспансеров. Для выявления связи (корреляции) между двумя переменными, принадлежащими к интервальной шкале и являющимися нормально распределёнными, использован коэффициент корреляции Пирсона r. Проверка закона распределения произведена с помощью теста Колмогорова-Смирнова. Результаты работы. Организация работа отделения ультразвуковой диагностики онкологического диспансера зависит от коечного фонда, штатного расписания, оснащённости учреждения, от показателей выявленных злокачественных новообразований и количества пациентов онкологического профиля, стоящих на диспансерном учёте. Коэффициент Пирсона равен +1, p=0,01. В тоже время, проведение статистического анализа не выявило связи показателей, характеризующих работу отделений ультразвуковой диагностики с показателями распространённости онкологического процесса (с распределением по стадиям), с численностью населения области. Также отсутствуют связи между показателями диагностической деятельности отделений ультразвуковой диагностики и показателями работы отделения лучевой диагностики. Выводы. При планировании работы отделения ультразвуковой диагностики онкологического диспансера нет необходимости учитывать численность населения области и показатели деятельности отделения лучевой диагностики. Значимыми факторами являются уровни заболеваемости злокачественными новообразованиями, количество пациентов онкологического профиля, поставленных на учёт, количество стоящих на диспансерном учёте пациентов в регионе, интенсивность работы, оснащённость и кадровое обеспечение онкологического диспансера., Actuality. Ultrasound Department organization of the oncologic center has been insufficiently studied. There is no complete information about the factors affecting the performance of this unit, the criteria for predicting and planning its work in the literature. The purpose of this work is to identify statistically significant factors that determine the performance of the ultrasound departments of cancer center. Methods: correlative analysis of report form No30 of Voronezh, Lipetsk and Kursk cancer centers has been performed. Pearson correlation coefficient r has been used to interval scale and being normally distributed. Verification of the distribution law has been made using the KolmogorovSmirnov test. Results. The work of the Ultrasound Department of oncological center depends on the bed fund, the staffing, equipment status of the clinic, on the indicators of detected malignant tumors and the number of patients standing on cancer records. Pearson's coefficient is +1, p=0.01. At the same time, the statistical analysis does not reveal the connection of diagnostic work of Ultrasound Department with the prevalence of cancer process (distribution by stages), with the population of the region. It can be stated that there are no links between the indicators of diagnostic activity of the Ultrasound Department and the indicators of the Radiology Department. Summary. Planning the work of the Ultrasound Department of cancer center does not need using account the population of the region and the performance of the Radiology Department. Significant factors are the incidence of malignant tumors, the number of registered patients in the region, the intensity of work equipment status and staffing of the cancer center.

Introduction: As cancer center funds are allocated toward several resources, clinical trial offices and the clinical trial infrastructure is constantly scrutinized. It has been shown that 20% of clinical trials fail to achieve their accrual goal and in an institutional level several trials are open with poor accrual. We sought to identify factors that are associated with clinical trial accrual and develop a model to predict clinical trial accrual Methods and material: We identified all clinical trials from 1999 to 2015 at UT Health Cancer Center San Antonio. We included observational as well as interventional clinical trials. We collected several variables such as type of study, type of malignancy, trial phase, PI of study. Results: In total we included 297 clinical trials. We identified several factors to be associated with clinical trial accrual (Sponsor type, trial phase, disease category, type of trial, disease state and whether the trial involved a new investigational agent). We developed a predictive model with an AUC of 0.65 that showed that observational, interventional, industry-sponsored trials and trials authored by the local PI were more likely to achieve their accrual goal. Conclusion: We were able to identify several factors that were significantly associated with clinical trial accrual. Based on these factors we developed a prediction model for clinical trial accrual. We believe that use of this model can help improve our cancer centers clinical trial portfolio and help in fund allocation. Keywords: Clinical trials, Prediction, Model, Accrual, Cancer center

In this study, we aimed to determine the personal, social and economic burden and the frequency of depression, as well as in caregivers of cancer patients who are being treated with chemotherapy in Turkey. The study is designed as a cross-sectional survey study using a 5-point Likert-type response scale, and the last part of the questionnaire includes the Beck Depression Inventory. The depression rate was found to be 64% (n = 476) among all subjects (n = 968), with 91% of those with depression demonstrating signs of mild depression. In this study, a significant difference was found between the presence of depression and age (young), sex (female), educational level (high), economic status (low), financial loss during treatment, patient's lack of knowledge about his/her diagnosis, metastatic disease and short survival time. In addition, 64% of all subjects had concerns of getting cancer, and 44% of all subjects had feelings of anger/rage against other people. In a multivariate regression analysis, the patient's lack of knowledge of the diagnosis was the independent risk factor. In conclusion, depression incidence and burden rate increased among cancer caregivers, and care burden was highly associated with depression. Accordingly, approaches to reducing the psycho-social effects of cancer should focus intensively on both the patients and their caregivers in Turkey. © 2016 John Wiley & Sons Ltd.

OBJECTIVE: Prostate cancer is among the most common cancers in males. Prostate cancer is androgen dependent in the beginning, but as time progresses, it becomes refractory to androgen deprivation treatment. At this stage, docetaxel has been used as standard treatment for years. Cabazitaxel has become the first chemotherapeutic agent which has been shown to increase survival for patients with metastatic Castrate Resistant Prostate Cancer (mCRPC) that progresses after docetaxel. Phase 3 TROPIC study demonstrated that cabazitaxel prolongs survival. PATIENTS AND METHODS: In this study, we evaluated a total of 103 patients who took cabaz-itaxel chemotherapy for mCRPC diagnosis in 21 centers of Turkey, retrospectively. This study included patients who progressed despite doc-etaxel treatments, had ECOG performance score between 0-2, and used cabazitaxel treatment. Patients received cabazitaxel 25 mg/m2 at every 3 weeks, and prednisolone 5 mg twice a day. RESULTS: Median number of cabazitaxel cures was 5.03 (range: 1-17). Cabazitaxel response evaluation detected that 34% of the patients had a partial response, 22.3% had stable disease and 32% had a progressive disease. Grade 3-4 hema-tological toxicities were neutropenia (28.2%), neutropenic fever (14.5%), anemia (6.7%), and thrombocytopenia (3.8%). In our study, median progression-free survival (PFS) was 7.7 months and overall survival (OS) was 10.6 months. CONCLUSIONS: This study reflects toxicity profile of Turkish patients as a Caucasian race. We suggest that cabazitaxel is a safe and effective treatment option for mCRPC patients who progress after docetaxel. Moreover, ethnicity may play important roles both in treatment response and in toxicity profile.

WOS: 000376904300006, PubMed ID: 27097941, OBJECTIVE: Prostate cancer is among the most common cancers in males. Prostate cancer is androgen dependent in the beginning, but as time progresses, it becomes refractory to androgen deprivation treatment. At this stage, docetaxel has been used as standard treatment for years. Cabazitaxel has become the first chemotherapeutic agent which has been shown to increase survival for patients with metastatic Castrate Resistant Prostate Cancer (mCRPC) that progresses after docetaxel. Phase 3 TROPIC study demonstrated that cabazitaxel prolongs survival. PATIENTS AND METHODS: In this study, we evaluated a total of 103 patients who took cabazitaxel chemotherapy for mCRPC diagnosis in 21 centers of Turkey, retrospectively. This study included patients who progressed despite docetaxel treatments, had ECOG performance score between 0-2, and used cabazitaxel treatment. Patients received cabazitaxel 25 mg/m(2) at every 3 weeks, and prednisolone 5 mg twice a day. RESULTS: Median number of cabazitaxel cures was 5.03 (range: 1-17). Cabazitaxel response evaluation detected that 34% of the patients had a partial response, 22.3% had stable disease and 32% had a progressive disease. Grade 3-4 hematological toxicities were neutropenia (28.2%), neutropenic fever (14.5%), anemia (6.7%), and thrombocytopenia (3.8%). In our study, median progression-free survival (PFS) was 7.7 months and overall survival (OS) was 10.6 months. CONCLUSIONS: This study reflects toxicity profile of Turkish patients as a Caucasian race. We suggest that cabazitaxel is a safe and effective treatment option for mCRPC patients who progress after docetaxel. Moreover, ethnicity may play important roles both in treatment response and in toxicity profile.

Aim: The objective of this study is to evaluate the febrile neutropenia attacks in the children who have been treated for cancer in our center. Material and Method: Between January 2000 and December 2005, 57 patients with lymphoma and solid organ tumors who, had a total of 206 attacks of febril neutropenia were evaluated retrospectively. Results: The mean absolute neutrophil count (ANC), absolute lymphocyte count (ALC), absolute monocyte count (AMC) levels at the time of febril neutropenia attacks were 296 +/- 342/mm(3), 518 +/- 896/mm(3), 144 +/- 262/mm(3), respectively. The mean C-reactive protein (CRP) level was 7.63 +/- 7.06 mg/dL, Hb level was 8.67 +/- 1.74 g/dL and fever was 38.5 +/- 0.2 degrees C. There were no infection focus in the 57.3% of the attacks (n=118) and the most common infection focuses were pharyngitis and mucositis and they were seen in the 14% and 12.1% of the attacks, respectively. Combination of third generation cephalosporins and aminoglycosides were given in 87.8% (n=181) of the attacks. Bacteremia was found in 14.6% (n=30). The rate of isolated gram negative bacteria (60%) was higher than the others. The most common agents isolated were E.coli, Enterobacter cloaca and S.epidermidis in 16.7%, 13.3% and 13.3%, respectively. The success rate of therapy was found as 67.5%. There were no correlations between the infection focus and AMC, ANC, CRP levels, and mucositis and bacteremia. The presence of mucositis prolonged the duration of hospitalization. There were no significant differences between therapy regimens according to success of therapy, bacteremia and duration of hospitalization. The duration of neutropenia was longer in neuroblastoma and brain tumors. The mortality rate was found as 1.45%. Conclusions: The rate of gram negative bacteremia was higher in our study. None of our patients had central venous catheters, so we thought that this could be the reason to the lower rate of isolated gram positive bacteria. The response rate to the treatment was good and mortality rate was low with the empirical treatment by cephalosporin and aminoglycoside combination.

Background: Nurses and other health care providers (HCPs) continue to be noncompliant with the guidelines of proper hand hygiene practices. Purpose: The purpose of this study was to explore the factors associated with hand hygiene compliance among HCPs during routine clinical. Methods: An observational study was conducted at an oncology hospital to examine hand hygiene practices observed during 612 procedures that were performed by 67 HCPs. Results: Hand hygiene compliance was 41.7% (n = 255) before procedure and 72.1% (n = 441) after the procedure. The overall compliance was only 34.3% (n = 210). Compliance with the standards of hand hygiene was higher in high-risk procedures (odds ratio [OR] = 1.77; 95% confidence interval [CI], 1.18-2.65) and when HCPs were exposed to blood (OR = 1.40; 95% CI, 1.07-1.73). Conclusion: The findings highlight the need to continue to push compliance with hand hygiene using innovative approaches that go beyond teaching and in-service training. © 2010 Elsevier Inc. All rights reserved.

Background: Cancer in pregnancy is a rare disease with breast cancer, cervical cancer, melanoma and Hodgkin's disease to be the most commonly diagnosed malignancies during gestation. Cancer of unknown primary (CUP) is a wellrecognized clinical disorder where the primary site can not be identified after a standard diagnostic approach. CUP in pregnancy has rarely been described. Materials and Methods: We searched MEDLINE and contacted cancer Centers in Europe, United States and Australia where patients with CUP or pregnant patients with cancer were diagnosed and treated. Results: Since 1976 we identified 18 pregnant women with CUP in a median gestational age of 34 weeks. Most of these patients were diagnosed with poorly-differentiated histology, had poor response to systemic treatment and a median maternal survival of 8 months. Seventy-two percent of mothers have died, while 80% of the newborns were alive and healthy. Almost one fourth of placentas examined showed metastatic disease. Conclusion: CUP during pregnancy is a very rare coexistence, usually has an aggressive disease with poor response to chemotherapy and a dismal prognosis. Both obstetricians and oncologists should be aware of this rare condition. 35 1 575 580

Introduction: Despite unique tumor epidemiology and a higher cancer incidence compared to pediatric patients, adolescents and young adults have not been receiving specialized, multidisciplinary, centralized care. In an effort to emphasize this need, we present outcome and toxicity data from a reference centre. Methods: Cohort of 150 patients aged 15-30 treated for malignant tumors of lymphoid and solid organs from 1986 to 2002. Results: Patients aged 15-19 commonly had lymphomas, germ cell tumors and pediatric sarcomas, whereas those aged 20-30 experienced germ cell tumors, lymphomas, melanomas and epithelial tumors more often. Overall 5- and 10-year survival was 80%, whereas 5-year and 10-year time to treatment failure was 68% and 43.5% respectively. 24% of patients experienced persistent, late treatment-related toxicities that interfered with their normal lifestyle. Conclusion: Despite the need for specialized care, psychosocial support and enrollment in clinical trials, youngsters have not been recognized as a patient group with distinct needs. Development of «Juvenile» oncology is required. © FESEO 2006. 8 6 444 449

Background. Although the TNM system is useful in predicting survival in resected colorectal cancer, heterogeneity within the same stages regarding prognosis exists. We are presenting a pooled analysis of prognostic factors from two randomized studies of adjuvant treatment conducted by the Hellenic Cooperative Oncology Group. Patients and Methods. Patients with stage II or III colon (n = 279) or rectal (n = 220) cancer were included in this analysis. Following surgery, patients received: 5-fluorouracil/leucovorin (5-FU/LV) (n = 135), 5-FU/LV and interferon Alfa-2a (IFNA-2a) (n = 138), 5-FU/LV and pelvic chemoradiotherapy (n = 106), and pelvic chemoradiotherapy alone (n = 108). Results. Median follow up was 92 mo. The number of involved lymph nodes (LNs), tumor differentiation, and the presence of regional implants were independent prognostic factors for both OS and TTP, while nerve invasion was only significant for TTP. Patients were stratified into three prognostic groups (low-risk: no LNs and grade 1/2; high-risk: > 3 LNs and grade 3/4; intermediate-risk: remaining patients) with distinct differences in 5-yr survival (84.7% vs 57.6% vs 32.4%) and 5-yr TTP (81.2% vs 54.5% vs 28.6%). Conclusion. The combination of clinicopathological prognostic factors can be more informative than the traditional TNM staging system. Such stratification may be necessary in randomized trials and could be useful in deciding the most appropriate adjuvant treatment strategies. © Copyright 2005 by Humana Press Inc. All rights of any nature whatsoever reserved. 36 1 29 38

Over 150,000 reproductive age individuals face fertility-threatening cancer treatments each year. Improved detection and treatment of cancer in reproductive-age patients have greatly increased the long-term survival and made it possible for these individuals to consider their long-term quality-of-life after cancer including having biologic offspring. Various methods of fertility preservation (FP) are now available for both males and females. In order to maximize FP options available to patients facing imminent gonadotoxic therapies, it is crucial that women have quick access to FP care and that providers expedite FP strategies. The overarching goal of a clinical FP program is to help patients and their physicians consider the impact of treatment on future fertility and facilitate FP efforts in what is often a limited time period before cancer treatment begins.

Organkrebszentren, hier beispielhaft am interdisziplinären Brustzentrum der Charité darstellt arbeiten als zentrale onkologische Versorgungsstrukturen in Deutschland. Ihre Arbeit ist geprägt durch ein hohes Maß an Interdisziplinarität unter Berücksichtigung einer leitlinienkonformen Diagnostik und Therapie. In der vorgestellten Arbeit wird anhand von exemplarisch fünf von mir gewählten Publikationen die lokale Umsetzung dieses Struktur- und Qualitätsanspruches dargestellt. Die Themenbereiche sind breit gefächert und spiegeln die heterogen und vielschichtigen Erfordernisse wieder. Unter dem Oberbegriff der Strukturprozessanalyse konnte anhand der Entwicklung und Implementierung eines klinischen Behandlungspfades für die operative Versorgung an Brustkrebserkrankter Frauen eine Optimierung der stationären Versorgung erreicht werden. Es wurde eine Reduktion der mittleren Verweildauer als auch eine Steigerung der Fallgesamtkosten erreicht, die zu einer verbesserten Ressourcennutzung führte. Im Rahmen der interdisziplinären Zusammenarbeit mit den fachlichen Kerngruppen wurden zwei thematisch pathologisch/klinische Fragestellungen erarbeitet. Dieses hatte neben wissenschaftlich interessanten Ergebnisse bezüglich der Korrelation von Stanzbiopsien und chirurgischen Exzsidaten als auch der Evaluation zweier neuer Marker zur Diagnose von neuroendokrinen Tumoren der Brust direkte Auswirkungen auf die tägliche Patientinnenversorgung. Mit dem Beitrag zur Untersuchung von endothelialen Vorläuferzellen beim Mammakarzinom konnte im lokalen Kontext eine translationale Fragestellung erarbeitet werden. Es wurde bei 47 Patientinnen eine signifikant höhere Anzahl an endothelialen Vorläufer gefunden. Dieses macht die wichtige Verzahnung von Grundlagenforschung mit klinischer Anwendung deutlich. Das Projekt der Entwicklung einer Berufsbegleitenden Ausbildung zur „Breast care nurse“ stellt ein hervorragendes Beispiel einer sektorenübergreifenden Arbeit dar, die mit viel Erfolg durchgeführt wurde. „Gelebte Interdisziplinarität“ ist machbar und führt zu einer hohen Zufriedenheit aller Berufsgruppen. Das Ziel ist die Verbesserung der Behandlung onkologisch erkrankter Menschen., Cancer centers, exemplary the breast cancer unit of the Charite universitiy clinic, work as leading units for oncological patients. Their work is described by an excellent interdisciplinary approach with intergrated standards of care. In this manusript the local transfer of standardization is shown exemplary in 5 publications. Working fields are diversified and show the heterogeneous requirements. The implementation of a clinical pathway in breast surgery showed the benefit of a structured quality assessment. We saw a reduced mean hospital stay with reduced costs. The second publication showed a good correlation between preoperative histological biospy results with the operation specimen with respect to histological markers. The third paper described a newly found marker for neuroendocrine tumors of the breast. As an example for translational research the forth paper showed the signifcant work with endothethial progenitor cells in breast cancer patients. As transsectorial work the breast care nurse education program was analysed. The aim has to be to improve the care for oncological patients.

Organkrebszentren, hier beispielhaft am interdisziplinären Brustzentrum der Charité darstellt arbeiten als zentrale onkologische Versorgungsstrukturen in Deutschland. Ihre Arbeit ist geprägt durch ein hohes Maß an Interdisziplinarität unter Berücksichtigung einer leitlinienkonformen Diagnostik und Therapie. In der vorgestellten Arbeit wird anhand von exemplarisch fünf von mir gewählten Publikationen die lokale Umsetzung dieses Struktur- und Qualitätsanspruches dargestellt. Die Themenbereiche sind breit gefächert und spiegeln die heterogen und vielschichtigen Erfordernisse wieder. Unter dem Oberbegriff der Strukturprozessanalyse konnte anhand der Entwicklung und Implementierung eines klinischen Behandlungspfades für die operative Versorgung an Brustkrebserkrankter Frauen eine Optimierung der stationären Versorgung erreicht werden. Es wurde eine Reduktion der mittleren Verweildauer als auch eine Steigerung der Fallgesamtkosten erreicht, die zu einer verbesserten Ressourcennutzung führte. Im Rahmen der interdisziplinären Zusammenarbeit mit den fachlichen Kerngruppen wurden zwei thematisch pathologisch/klinische Fragestellungen erarbeitet. Dieses hatte neben wissenschaftlich interessanten Ergebnisse bezüglich der Korrelation von Stanzbiopsien und chirurgischen Exzsidaten als auch der Evaluation zweier neuer Marker zur Diagnose von neuroendokrinen Tumoren der Brust direkte Auswirkungen auf die tägliche Patientinnenversorgung. Mit dem Beitrag zur Untersuchung von endothelialen Vorläuferzellen beim Mammakarzinom konnte im lokalen Kontext eine translationale Fragestellung erarbeitet werden. Es wurde bei 47 Patientinnen eine signifikant höhere Anzahl an endothelialen Vorläufer gefunden. Dieses macht die wichtige Verzahnung von Grundlagenforschung mit klinischer Anwendung deutlich. Das Projekt der Entwicklung einer Berufsbegleitenden Ausbildung zur „Breast care nurse“ stellt ein hervorragendes Beispiel einer sektorenübergreifenden Arbeit dar, die mit viel Erfolg durchgeführt wurde. „Gelebte Interdisziplinarität“ ist machbar und führt zu einer hohen Zufriedenheit aller Berufsgruppen. Das Ziel ist die Verbesserung der Behandlung onkologisch erkrankter Menschen., Cancer centers, exemplary the breast cancer unit of the Charite universitiy clinic, work as leading units for oncological patients. Their work is described by an excellent interdisciplinary approach with intergrated standards of care. In this manusript the local transfer of standardization is shown exemplary in 5 publications. Working fields are diversified and show the heterogeneous requirements. The implementation of a clinical pathway in breast surgery showed the benefit of a structured quality assessment. We saw a reduced mean hospital stay with reduced costs. The second publication showed a good correlation between preoperative histological biospy results with the operation specimen with respect to histological markers. The third paper described a newly found marker for neuroendocrine tumors of the breast. As an example for translational research the forth paper showed the signifcant work with endothethial progenitor cells in breast cancer patients. As transsectorial work the breast care nurse education program was analysed. The aim has to be to improve the care for oncological patients.

WOS: 000274672100005, PubMed ID: 19535217, Objective: In the study, our aim was to evaluate the predictability of four different nomograms on non-sentinel lymph node metastases (NSLNM) in breast cancer (BC) patients with positive sentinel lymph node (SLN) biopsy in a multi-center study. Methods: We identified 607 patients who had a positive SLN biopsy and completion axillary lymph node dissection (CALND) at seven different BC treatment centers in Turkey. The BC nomograms developed by the Memorial Sloan Kettering Cancer Center (MSKCC), Tenon Hospital, Cambridge University, and Stanford University were used to calculate the probability of NSLNM. Area under (AUC) Receiver Operating Characteristics Curve (ROC) was calculated for each nomogram and values greater than 0.70 were accepted as demonstrating good discrimination. Results: Two hundred and eighty-seven patients (287) of 607 patients (47.2%) had a positive axillary NSLNM. The AUC values were 0.705, 0.711, 0.730, and 0.582 for the MSKCC, Cambridge, Stanford, and Tenon models, respectively. On the multivariate analysis; overall metastasis size (OMS), lymphovascular invasion (LVI), and proportion of positive SLN to total SLN were found statistically significant. We created a formula to predict the NSLNM in our patient population and the AUC value of this formula was 0.8023. Conclusions: The MSKCC, Cambridge, and Stanford nomograms were good discriminators of NSLNM in SLN positive BC patients in this study. A newly created formula in this Study needs to be validated in prospective studies in different patient populations. A nomogram to predict NSLNM in patients with positive SLN biopsy developed at one institution should be used with caution. (C) 2009 Elsevier Ltd. All rights reserved.

Pregnancy-associated breast cancer (PABC) is a rare and challenging problem. We sought to describe epidemiology, management and outcome of women in whom breast cancer was diagnosed during pregnancy or within one year after delivery. Thirty-two women with PABC were referred to two European Union oncology centers between 1995 and 2007,16 during pregnancy and 16 within 1 year after delivery. Data concerning diagnosis, management, delivery and fetal and maternal outcome were recorded. A group of 32 patients (matched controls) presenting with nonpregnancy-associated breast cancer (non-PABC) was matched for age at diagnosis, tumor size and stage to each PABC patient. Differences in outcome between the PABC and non-PABC groups were then assessed. Histological features were similar in both groups, except that estrogen receptor-negative tumors were more common in the PABC group. Three patients received chemotherapy and two others underwent surgery during pregnancy, with no excess toxicity or severe maternal/fetal adverse effects. All children in the PABC group were healthy, except for one exposed to epirubicin in utero and born with rectal atresia. Overall survival was similar in PABC and non-PABC patients (p = 0.449). The subgroup of patients with breast cancer diagnosed within one year after delivery showed a shorter time to relapse than controls or patients with gestational cancer (p = 0.0178). PABC is a special situation, necessitating individualized, multi-disciplinary management. Prognosis is similar for women with nongestational cancer matched for age and stage though poorer outcome postpartum should be further investigated. © 2009 Wiley Periodicals, Inc. 15 5 461 467

Objective: To determine the level of agreement between patients and observers regarding the frequency with which health-related quality of life topics are discussed during outpatient clinical oncology visits. Methods: The sample (n = 50) consisted of a consecutive series of cancer patients undergoing chemotherapy. Both the patients and observers used a checklist to report which HRQL topics had been discussed during the consultation. Percentage of agreement, kappa and adjust-kappa statistics were calculated. Results: The percentage agreement between patients' and observers' ratings was generally high, ranging from 74% for fatigue to 96% for sleep problems and cognitive functioning. The average percentage of agreement over the 13 HRQL topics rated was 86%. Cohen's kappa varied between 0.41 (for pain) and 0.78 (for sleep problems). Prevalence-adjusted kappa's were generally higher, ranging from 0.48 (for fatigue) to 0.92 (for sleep problems and social functioning). The average Cohen's kappa and prevalence-adjusted kappa over the 13 HRQL topics were 0.56 and 0.71, respectively. Level of agreement was not found to vary significantly as a function of patients' background characteristics. Conclusion: Oncology patients' self-reports of the HRQL-related topics discussed during outpatient chemotherapy visits are in reasonably close agreement with those provided by observers. Practice implications: Our results indicate that the patient is a legitimate source of information about the HRQL-related content of medical encounters, and thus can be used in communication studies where the collection of observational data (e.g., via audio- or videotaping) is either too costly or logistically impractical. © 2006 Elsevier Ireland Ltd. All rights reserved. Chemicals / CAS: Antineoplastic Agents

Objective: To determine the level of agreement between patients and observers regarding the frequency with which health-related quality of life topics are discussed during outpatient clinical oncology visits. Methods: The sample (n = 50) consisted of a consecutive series of cancer patients undergoing chemotherapy. Both the patients and observers used a checklist to report which HRQL topics had been discussed during the consultation. Percentage of agreement, kappa and adjust-kappa statistics were calculated. Results: The percentage agreement between patients' and observers' ratings was generally high, ranging from 74% for fatigue to 96% for sleep problems and cognitive functioning. The average percentage of agreement over the 13 HRQL topics rated was 86%. Cohen's kappa varied between 0.41 (for pain) and 0.78 (for sleep problems). Prevalence-adjusted kappa's were generally higher, ranging from 0.48 (for fatigue) to 0.92 (for sleep problems and social functioning). The average Cohen's kappa and prevalence-adjusted kappa over the 13 HRQL topics were 0.56 and 0.71, respectively. Level of agreement was not found to vary significantly as a function of patients' background characteristics. Conclusion: Oncology patients' self-reports of the HRQL-related topics discussed during outpatient chemotherapy visits are in reasonably close agreement with those provided by observers. Practice implications: Our results indicate that the patient is a legitimate source of information about the HRQL-related content of medical encounters, and thus can be used in communication studies where the collection of observational data (e.g., via audio- or videotaping) is either too costly or logistically impractical. © 2006 Elsevier Ireland Ltd. All rights reserved. Chemicals / CAS: Antineoplastic Agents

This study was designed to evaluate the presence and the level of acute fatigue syndrome in patients with Hodgkin's and Non-Hodgkin's lymphoma. Another aim was to define the risk factors that influence the fatigue. To evaluate the acute fatigue syndrome a questionnaire developed by The MD Anderson Cancer Center called "Brief Fatigue Inventory" was used. Data from the study was analysed with variance analysis, correlation and t-test. Overall fatigue level and the impact of fatigue on daily activities were moderate in patients with lymphoma. Advanced age, female sex, illiteracy, being widow or house wife, presence of other chronic disease, hospitalization during chemotherapy were all potantial factors that correlated with increased feeling of fatigue (p0.05). In conclusion, it is recommended that the level of acute fatigue syndrome, which is frequently seen in lymphoma patients, should be determined.