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Background Technology-based interventions are increasingly being introduced in routine clinical cancer care. There is a need for reliable systems to monitor treatment-related toxicity in a standardized manner. Such electronic tools bridge the gap in providing quality home-based monitoring. Methods From July 2017 to December 2017, we performed a multicentered, non-randomized prospective cohort analysis with patients who were receiving routine chemotherapy for various solid tumors, using a web-based patient-reported toxicity registration, management, and intervention system called AMTRA (ambulatory Monitoring of cancer Therapy using an interactive Application) linked to the homecare nursing organization Remedus (R). Twelve common toxicities plus pain and two biometrics could be registered daily or more frequently as required. These were processed centrally to generate tailored advice for lesser symptoms or a phone call from a dedicated nurse in case of severe or prolonged toxicity. A compliance tool to monitor oral therapies was incorporated in the system. Results One hundred sixty-eight patients (92%) were enrolled, with 31,514 registrations analyzed. One hundred eight patients reported severe toxicity (> 1461 registrations), resulting in 102 clinical interventions ranging from self-management advice, supplemental consultations to hospitalizations. Compliance to oral chemotherapy was high using AMTRA with a median of 98.7% (95 confidence interval (CI) [93.5-100.0%]). Seventy-nine percent of patients stated that the availability of AMTRA self-reports was useful in communication with the care provider, while 75% felt more in control while managing their treatment. Conclusions The application of an interactive PRO-system in routine symptom management of cancer patients allowed standardized documentation of toxicities and recorded a high compliance with oral treatment. It allows for rapid interaction for toxicities and cancer-related symptoms experienced at home.

Non-invasive prenatal screening: detection of sex chromosomal aneuploidies. Desirability of reporting these findings to pregnant women On 30 April 2021, the Belgian Advisory Committee on Bioethics issued opinion No. 76 regarding the desirability to report sex chromosomal aneuploidies (SCAs) detected by non-invasive prenatal testing (NIPT). Debate is ongoing in the medical community as to whether it is appropriate to report an SCA of the fetus to the pregnant woman when this abnormality is detected by a genome-wide NIPT. This question presupposes that SCAs should be screened for in the first place. This does not necessarily have to be the case, neither technically nor ethically: if a targeted genome screening was to be conducted instead of the nowadays preferred genome-wide approach, these SCAs would not be automatically identified. The Committee argues that there are insufficient reasons for including SCAs in standard prenatal NIPT screening and reporting. Good quality pre- and post-test counseling is paramount to make sure that expectant parents are making decisions they feel comfortable with down the line. This requires manageable information about the general aim, scope and method of NIPT screening, the reliability and validity of the test, the need to perform invasive prenatal testing in case of positive results, clarity on what the results may imply, and information that extends beyond medical descriptions of the conditions screened for. The Committee stresses that this condition is, at this moment, insufficiently met.

ObjectivesTo investigate whether MTX should be combined with an additional DMARD and bridging glucocorticoids as initial treatment for patients with early RA to induce an effective long-term response.MethodsThe Care in early RA study is a two-year investigator-initiated pragmatic multicentre randomized trial. Early RA patients, naïve to DMARDs and glucocorticoids, were stratified based on prognostic factors. High-risk patients were randomized to COBRA-Classic (n = 98): MTX, sulfasalazine, prednisone step-down from 60 mg; COBRA-Slim (n = 98): MTX, prednisone step-down from 30 mg; or COBRA-Avant-Garde (n = 93): MTX, leflunomide, prednisone step-down from 30 mg. Low-risk patients were randomized to COBRA-Slim (n = 43); or Tight Step Up (TSU) (n = 47): MTX without prednisone. Clinical/radiological outcomes at year 2, sustainability of response, safety and treatment adaptations were assessed.ResultsIn the high-risk group 71/98 (72%) patients achieved a DAS28-CRP < 2.6 with COBRA-Slim compared with 64/98 (65%) with COBRA-Classic and 69/93 (74%) with COBRA-Avant-Garde (P = 1.00). Other clinical/radiological outcomes and sustainability of response were similar. COBRA-Slim treatment resulted in less therapy-related adverse events compared with COBRA-Classic (P = 0.02) or COBRA-Avant-Garde (P = 0.005). In the low-risk group, 29/43 (67%) patients on COBRA-Slim and 34/47 (72%) on TSU achieved a DAS28-CRP < 2.6 (P = 1.00). On COBRA-Slim, low-risk patients had lower longitudinal DAS28-CRP scores over 2 years, a lower need for glucocorticoid injections and a comparable safety profile compared with TSU.ConclusionAll regimens combining DMARDs with glucocorticoids were effective for patients with early RA up to 2 years. The COBRA-Slim regimen, MTX monotherapy with glucocorticoid bridging, provided the best balance between efficacy and safety, irrespective of patients’ prognosis.Trial registrationClinicalTrials.gov, http://www.clinicaltrials.gov, NCT01172639.

Context: Although training with an aquabag (AB) has gained popularity, there is a lack of evidence of its effect. This study wanted to evaluate the effect of AB implementation on muscle activity of core and lower limb muscles during 3 functional exercises. Design: Cross-sectional observational study. Methods: Twenty healthy subjects performed a squat, lunge, and step-up, while using a stick and an AB. Surface electromyography signals were recorded from the trunk, pelvis, and thigh muscles in the dominant leg. Linear-mixed models were used to analyze the normalized surface electromyography signals. Results: Results demonstrated a significant increase in muscle activity of the back muscles during all 3 exercises (P P = .003), abdominals during squat (P = .034) and step-up (P = .046), hamstrings during lunge (P = .008) and step-up (P = .008), and gluteal muscles during lunge (P P = .010, respectively). Conclusions: These results indicate that an AB promotes functional strength training by demanding compensatory/additional activity of both stabilizing muscles (specifically in the core and pelvis regions) and prime movers of the lower limb. The authors recommend the use of an AB to enhance training and rehabilitation effects.

Background Telehealth modalities were introduced during the SARS-CoV-2 pandemic to assure continuation of cancer care and maintain social distance. Methods This is a retrospective cohort analysis of our telehealth expansion programme. We adapted two existing patient-reported outcome (PRO) telemonitoring tools that register and (self-)manage toxicities to therapy, while screening for SARS-CoV-2-related symptoms. Outpatients from a tertiary cancer centre were enrolled. The adapted PRO interface allowed for uniform registration of SARS-CoV-2-related symptoms and effective triage of patients at home where we also implemented systematic throat washings, when available. Results Three hundred and sixty patients registered to the telemonitoring systems from March 13 to May 15, 2020. Four prespecified SARS-CoV-2 alarms resulted in three patients with positive PCR testing. Other Covid-19 symptoms (fever 5× and cough 2×) led to pretreatment triage resulting in 1 seroconversion after initial negative testing. One of the 477 throat washings proved positive. Conclusions The rapid adoption of an amended PRO (self-)registrations and toxicity management system was feasible and coordinated screening for Covid-19. Continued clinical cancer care was maintained, with significant decreased waiting time. The systemic screening with throat washings offered no real improvement.

COVID-19 is an infectious pandemic disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus with varying presentations ranging from asymptomatic, sensation of a mild cold or influenza to severe bilateral pneumonia and death.1 Patients with cancer and COVID-19 are at a significantly higher likelihood of poor disease outcomes.2 3 In the absence of a vaccine or adequate treatment of COVID-19 current measures to minimise the infectious risk of SARS-CoV-2 in a cancer patient population are focused on physical distancing and protective measures. As it is clear that a hospital is a high-risk setting to contract COVID-19, one of the strategies we can use to treat patients with cancer as safe as possible is to reduce hospital visits to a strict minimum. We previously reported on AMTRA …