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Aim: To evaluate the ex vivo efficacy of chemotherapy, immunotherapy and targeted agents with the oncogram method in patients with bladder cancer and determine the most appropriate personalized treatment agent using immune markers. Materials & methods: Bladder cancer tissues were obtained from each patient. After cultivation, cell cultures were divided into 12 groups for each patient and 11 drugs were administered. Cell viability and immunohistochemistry expression were examined. Results: A good response rate was determined to be a 23% viability drop. The nivolumab good response rate was slightly better in PD-L1-positive patients and the ipilimumab good response rate was slightly better in tumoral CTLA-4-positive cases. Interestingly, the cetuximab response was worse in EGFR-positive cases. Conclusion: Although good responses of drug groups after their ex vivo application by using oncogram were found to be higher than control group, this outcome differed on a per patient basis. Plain language summaryBladder cancer primary cell cultures were shown to be effective for drug sensitivity and also able to be used ex vivo in the process of determining personalized treatment. The ex vivo efficacy of 11 different agents was evaluated with oncogram in bladder cancer cell cultures obtained from patients. Together with clinicopathological features, evaluation of drug responses detected by oncogram can provide important information for pretreatment drug selection when deciding on individualized treatment. Tweetable abstractEvaluation of drug responses detected by oncogram can provide important information for pretreatment drug selection when determining individualized treatment. These results show us that the Anna Karenina principle can be adapted to bladder cancer.

Tweetable abstractThe prognostic nutritional index (PNI) as a useful, simple and new prognostic indicator in patients with HR-positive, HER2-negative metastatic breast cancer treated with CDK4/6 inhibitor + endocrine therapy. Aims: The aim of this study was to evaluate the effect of prognostic nutritional index (PNI) on prognosis in patients with hormone receptor-positive, HER2-negative metastatic breast cancer who received CDK4/6 inhibitor + endocrine therapy. Methods: Patients receiving a CDK4/6 inhibitor were evaluated retrospectively. The PNI was calculated as: (10 x serum albumin [g/dl]) + (total lymphocyte count [x10(9)/l] x 5). Results: In a study of 106 patients, a statistically significant survival advantage was observed in the high-PNI group over the low-PNI group (mean overall survival: 28.03 +/- 0.487 months vs 22.46 +/- 1.14 months; p = 0.013). Conclusion: For the first time in the literature, this study demonstrated the prognostic role of PNI in patients with hormone receptor-positive, HER2-negative metastatic breast cancer treated with CDK4/6 inhibitors. Plain language summaryWhat is this article about? In cancer, in addition to known prognostic and predictive markers (e.g.,age, performance status, clinicopathological features and disease stage), nutritional status and immunity can predict treatment response and survival in many cancer types. In recent studies, simple indices have been created from various parameters available from blood samples. The prognostic nutritional index (PNI) is a simple immune-nutritional marker calculated using albumin, which reflects the nutritional status, and lymphocytes (immune cells). The predictive value of PNI in patients receiving conventional treatments (e.g., chemotherapy and radiotherapy) has been demonstrated in various cancers, including breast cancer, but there is no information about the prognostic and predictive value of PNI in patients treated with CDK4/6 inhibitor + endocrine therapy (ET), a targeted therapy recommended as first-line therapy in hormone receptor-positive, HER2-negative metastatic breast cancer (HR+, HER2(-) MBC). What were the results? We investigated the effect of the immune-nutritional status of patients using CDK4/6 inhibitors and ET on response to treatment and overall survival in HR+, HER2(-) MBC. Patients with high PNI values had longer survival and, although not statistically significant, higher treatment response rates. What do the results of the study mean? Although the number of patients in our study was small, this result showed that the immune-nutritional status should be evaluated appropriately and necessary support should be given in patients receiving CDK4/6 inhibitors. Due to the small number of patients in the study, we believe that the importance of PNI can be further emphasized with prospective and multicenter studies.

Background: Most of the studies on salivary gland cancers are limited for various reasons such as being single-center, small number of patients, including only major or minor SGCs, or only including epidemiological data. Methods: A total of 37 medical oncology clinics from different regions of Turkey participated in this retrospective-multicenter study. The analyzed data included clinical and demographical features, primary treatment, metastasis localizations, and treatments and includes certain pathologic features. Results: The study included data from a total of 443 SGCs. 56.7% was in major salivary glands and 43.3% was in minor salivary glands. Distant metastasis in the major SGCs was statistically significantly more common than in the minor SGCs, locoregional recurrence was statistically significantly more common in the minor SGCs than in the major SGCs (p = 0.003). Conclusions: Epidemiological information, metastasis and recurrence patterns, treatment modalities, and survival analysis of the patients over 20 years of follow-up are presented.

PurposeTo identify the predictors of the 6-min walk test (6MWT) and investigate the relationship between 6MWT, performance status, functional mobility, fatigue, quality of life, neuropathy, physical activity level, and peripheral muscle strength in patients with ovarian cancer (OC).MethodsTwenty-four patients diagnosed with stage II-III ovarian cancer were included in the study. Patients were assessed using the following measurement methods: 6MWT for walking capacity, Eastern Cooperative Oncology Group Performance Scale (ECOG-PS) for performance status, an armband physical activity monitor for physical activity level, Checklist Individual Strength (CIS) for fatigue, Functional Cancer Treatment Evaluation with Quality of Life-Extreme (FACT-O) for quality of life, Functional Evaluation of Cancer Treatment/Gynecological Oncology-Neurotoxicity (FACT/GOG-NTX) for neuropathy, a hand-held dynamometer for peripheral muscle strength, and 30-s chair-stand test for functional mobility.ResultsThe mean 6MWT distance was 578.48 +/- 115.33 meters. 6MWT distance correlated with ECOG-PS score (r = -0.438, p = 0.032), handgrip strength (r = 0.452, p= 0030), METs (r = 0.414, p = 0.044) 30s-CST (r= 0.417, p= 0.043), and neuropathy score (r = 0.417, p = 0.043) significantly. There was no relationship between 6MWT distance and other parameters (p> 0.05). Multiple linear regression analysis demonstrated that performance status was the sole predictor of 6MWT.ConclusionThe walking capacity seems to be associated with performance status, peripheral muscle strength, level of physical activity, functional mobility, and severity of neuropathy in patients with ovarian cancer. Evaluating these may help clinicians to understand factors behind the decreased walking capacity.

Breast cancer, a worldwide leading cause of cancer in women, may occur in familial cases. Germline mutations in BRCA1/2 genes are responsible for 15% of the familial cases. With the power of next generation sequencing (NGS) analysis, it is possible to analyze genes related to hereditary susceptibility to breast cancer and investigate the genetic etiology more thoroughly.In this study, we investigated 30 genes identified frequent pathogenic alleles in Turkish population. The study includes 495 unrelated individuals diagnosed with breast cancer who are selected for genetic testing according to NCCN criteria for hereditary breast cancer. All patients were analyzed by NGS for BRCA1/2 genes. Deletion/duplication investigation by Multiplex ligation-dependent probe amplification (MLPA) and massive sequencing of 30 breast cancer-related genes (Oncorisk Gene Panel) were performed in a stepwise manner. BRCA1/2 variants are the most frequent pathogenic variants which are found in 45 of 495 (9.1%) patients. Four previously unreported, novel, pathogenic variants of BRCA2 gene are identified. In four cases, exonic deletions of BRCA1/2 genes are determined and there is no duplication of these genes. NGS panel investigation involving other moderate-high risk genes contributed genetic diagnosis in an extra 39 out of 419 (9.3%) cases. Our study presents the cost effectiveness of the gene panel approach. We suggest that gene panels should be the first-tier genetic testing for hereditary breast cancer and MLPA analysis of BRCA1/2 genes should be investigated as a complementary method of NGS analysis. (c) 2022 Published by Elsevier Inc.

Background: Ribociclib, palbociclib and abemaciclib are currently approved CDK4/6 inhibitors along with aromatase inhibitors as the first-line standard-of-care for patients with hormone receptor-positive, HER2-negative metastatic breast cancer. Methods: The authors report retrospective real-life data for 600 patients with estrogen receptor- and/or progesterone receptor-positive and HER2-negative metastatic breast cancer who were treated with ribociclib and palbociclib in combination with letrozole. Results & conclusion: The results demonstrated that the combination of palbociclib or ribociclib with letrozole has similar progression-free survival and overall survival benefit in real life for the patient group with similar clinical features. Specifically, endocrine sensitivity may be a factor to be considered in the treatment preference.

Background: The combination of endocrine therapy and CDK 4/6 inhibitors in the treatment of hormone receptor positive, HER-2 negative metastatic breast cancer resulted in significant increases in survival.In general, the presence of malnutrition in cancer patients is a condition that negatively affects the success of treatment. For this reason, it is important to evaluate the nutritional status of cancer patients and to give appropriate nutritional support. One of the most widely used nutritional assessment methods in the literature is the Prognostic Nutritional Index (PNI). In this study, it was aimed to evaluate the effect of PNI on treatment response and prognosis in patients with HR+ HER-2- metastatic breast cancer who received CDK 4/6 inhibitor together with endocrine therapy. Materials and Methods: Patients with HR+ HER-2- metastatic breast cancer who received CDK 4/6 inhibitor together with endocrine therapy were evaluated retrospectively. In all patients, PNI values were recorded on the day of initiation of treatment and at the 3rd month after treatment. The Prognostic Nutritional Index was calculated as follows: serum albumin (gr/dl) + (total lymphocyte count (109/L) X 5). The optimal cutoff value for the pre-treatment PNI score was 49 as a result of the ROC analysis, and the patients were divided into two groups as low PNI group (> 49.0). Results: A total of 106 patients with HR+ HER-2- metastatic breast cancer who received CDK 4/6 inhibitor therapy together with endocrine therapy were evaluated. While 47 (44.3%) of the patients were receiving AI + CDK 4/6 inhibitor treatment; 59 (55.7%) were taking fulvestrant + CDK 4/6 inhibitor. According to the pre-treatment PNI score, 40 (37.7%) of the patients in the whole group were in the low PNI group and 66 (62.3%) were in the high PNI group. When the effect of PNI on treatment response in the whole group was analyzed, it was found that a numerically higher response was obtained, although not statistically significant, in the group with high pre-treatment PNI compared to the group with low PNI (ORR: 61.1% vs 53.8%, respectively; p=0.301). Similarly, when the effect of PNI on PFS and OS in the whole group was analyzed, it was observed that the group with high pre-treatment PNI had a numerically higher, but not statistically significant, advantage of PFS and OS compared to the low group (mean PFS is 22.56 ± 1.28 vs 19.52 ± 1.30, p=0.757, respectively; and mean OS is 27.43 ± 0.61 vs 20.55 ± 1.17, p=0.055, respectively). It was determined that numerically similar response and survival advantages continued in both endocrine therapy subgroups. Conclusion: The results we obtained from this study suggest that PNI may have a potentially predictive and prognostic role in patients with HR+ HER-2- metastatic breast cancer treated with CDK 4/6 inhibitor together with endocrine therapy. To the best of our knowledge, this is the first study in the literature to date with CDK 4/6 inhibitors. We think that evaluating the nutritional status before treatment and providing appropriate nutritional support in patients receiving these treatments may increase the success of the treatment.

Background: The purpose of the study was to investigate the effect of using Kinesio Taping (R) (KT) on anastomotic regions along with complex decongestive physiotherapy (CDP) in patients with breast cancer-related lymphedema (BCRL). Methods and Results: Patients with unilateral BCRL were divided into two groups in this randomized controlled study: Group 1 (CDP, n = 14) and Group 2 (CDP+ KT, n = 18). Assessment of limb size was quantified by using circumferential limb measurements and then calculated for each segment by using the frustum formula. CDP included manual lymphatic drainage, compression bandages, exercises, and skin care. KT was applied to lymphatic anastomosis. All patients received treatment for 1 hour per day, 5 days per week for 4 weeks. The outcome measure was difference in the reduction of limb volumes between the groups. There was a significant difference in both groups before and after treatment (p < 0.05), but there was no significant difference between the two groups regarding changes in limb volume (p > 0.05). Conclusion: The results suggest that applying KT to lymphatic anastomotic regions is not effective in reducing limb volume in the management of BCRL.

Background Physical activity (PA) is a modifiable health behaviour in patients with colorectal cancer (CRC). Knowing the possible predictors of PA will contribute to producing physical and psychological benefits for CRC patients. Objective To investigate the factors that influence PA in patients with CRC. Methods This cross-sectional study was conducted with 47 participants with CRC. Demographic and clinical characteristics, neuropathic pain (Douleur Neuropathique 4 (DN4)), peripheral muscle strength (knee extensor and flexor, hip extensor and flexor, and ankle dorsiflexor muscle strength), balance (Balance Master System (BMS) and Berg Balance Scale (BBS)), fatigue (Brief Fatigue Inventory (BFI)), PA (International PA Questionnaire Short Form (IPAQ-SF)), and quality of life (36-item Short Form Health Survey (SF-36)) were evaluated. Multiple linear regression analysis was used to determine the variables that have the greatest influence on PA. Results IPAQ-SF score had moderate correlations with knee extensor muscle strength (r= 0.310,p= 0.034), BBS (r= 0.361,p= 0.013), and limit of stability test (movement velocity) score (r= 0.385,p= 0.008), BFI- severity of fatigue (r= - 0.488,p= 0.001), impact of fatigue on daily functioning (r= - 0.421,p= 0.003), and the SF-36 sub-parameters (role limitations due to physical health problems, physical functioning, general health perceptions and vitality) (p< 0.05). Role limitations due to physical problems, knee extensor muscle strength, and severity of fatigue had the greatest influence on PA in patients with CRC with explaining 43% of the variance in PA. Conclusions This study suggests that quality of life, knee extensor muscle strength, and fatigue have the greatest influence on PA in patients with CRC.

Purpose: Breast cancer is the most common cancer amongst women both in Turkey and in the world. Lymphedema, which negatively affects the quality of life, is one of the most prevalent problems reported by breast cancer survivors. Upper Limb Lymphedama 27 (ULL-27) questionnaire is a valid and reliable tool that assesses the quality of life in patients with breast cancer-related lymphedema. Until now, a Turkish-language version was lacking. The aim of this study was to perform a cross-cultural validation and reliability of the Turkish version of the ULL-27 questionnaire. Methods: This cross-sectional study involved forward- backward translation, and cross-cultural adaptation. 81 women (mean age and body mass index 54.96 ± 11.35 years and 29.50 ± 5.74 kg/m2) who had breast cancer related-upper extremity lymphedema were evaluated using the ULL-27 Quality of life questionnaire-Turkish version. Assessment of limb size was quantified by using circumferential limb measurements. European Organization for Research and Treatment of Cancer (EORTC) 30-item Quality of Life Questionnaire and Quality of Life Questionnaire breast cancer-23 (QLQ-BR23) were analyzed by Pearson's correlation analysis with the ULL-27 Turkish Version to indicate the convergent validity. Cronbach's alpha (internal consistency) and exploratory factor analysis were used to assess the questionnaire's reliability. Results: The mean of lymphedema duration and severity were 23.12 ± 30.88 months. Mild lymphedema was reported in 42% (34 people) of the cases included in the study. It was observed that 33.3% (27 people) had moderate lymphedema and 24.7% (20 people) had severe lymphedema. The alpha coefficient (internal consistency) for the Turkish ULL-27 total score was high (alpha = 0.93). Content validity was good because all questions were understandable for all participants (The alpha coefficient for the subgroups of the scale of physical, psychological, social scores, were 0.90, 0.87, and 0.75, respectively). External construct validity was highly confirmed by expected correlations with comparator scales, EORTC-30, and QLQ-BR23 (p < 0.01). Conclusions: The Turkish version of the ULL-27 Questionnaire is a valid and reliable tool for evaluating QoL in women with upper limb lymphedema related to breast cancer.

BackgroundCombination of gemcitabine and nab-paclitaxel has superior clinical efficacy than gemcitabine alone. Nevertheless, health-related quality of life. (QoL) associated with this combination therapy when administered at first-line in advanced pancreatic adenocarcinoma is unknown.MethodsA total of 125 patients were randomized to combination therapy (1000mg/m2 gemcitabine +125mg/m2 nab-paclitaxel) and single-agent gemcitabine (1000mg/m2) arms to take treatment weekly for 7 of 8weeks, and following 3 of 4weeks, until progression or severe toxicity. Primary endpoints were three-months of definitive deterioration free percent of patients, and QoL.ResultsOverall QoL analyses showed that 34 and 58.3% of cases in gemcitabine and gemcitabine+nab-P arms had no deterioration in 3rd month QoL scores (p=0.018). These proportions were 27.3 and 36.6% in 6(th) month assessments, respectively (p=0.357). Median overall survivals in combination and single-agent arms were 9.92months and 5.95months, respectively (HR: 0.64, 95% CI: 0.42-0.86, p=0.038). Median progression free survivals in these treatment arms were 6.28 and 3.22months, respectively (HR: 0.58, 95% CI: 0.39-0.87, p=0.008). Median time-to-deterioration were 5.36 vs 3.68months, and objective response rates were 37.1% vs 23.7% (p=0.009), respectively in combination and single-agent arms.ConclusionsCombination therapy with gemcitabine + nab-paclitaxel had better overall and progression-free survival than gemcitabine alone. Also, combination therapy showed increased response rate without toxicity or deteriorated QoL. Combination treatment with gemcitabine and nab-paclitaxel may provide significant benefit for advanced pancreatic cancer.Trial registrationThis study has been registered in ClinicalTrials.gov as NCT03807999 on January 8, 2019 (retrospectively registered)., Celgene [aaaa] Funding Source: Medline; onkoloji arastirmalari dernegi [aaa] Funding Source: Medline; hacettepe onkoloji dernegi [wwww] Funding Source: Medline; Turk Kanser Arastirma ve Savas Kurumu Dernegi [awe] Funding Source: Medline; Turk Tibbi Onkoloji Dernegi (TR) [wwww] Funding Source: Medline

The prognosis of melanoma is extremely poor. There are no biomarker that indicate the prognosis. The indirect markers of the antitumoral response such as the neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR), derived NLR (dNLR), absolute neutrophil count (ANC), absolute lymphocyte count (ALC) etc. have recently begun to be emphasized. Increased NLR, PLR and dNLR as a consequence of chronic inflammation have been found to be associated with poor prognosis in many cancers. The aim of this study is explore the role of this parameters in patients with early-stage melanoma. We retrospectively evaluated 120 patients admitted to our clinic with stage I-Ill melanoma with ANC, ALC, absolute platelet count(APC), as well as NLR, dNLR, and PLR values at the time of diagnosis, relaps and metastasis and evaluate their impact on prognosis. Patients with active infection, receiving steroids, with a chronic inflammatory disease that may alter the hematological parameters, and those with another malignancy other than melanoma were excluded. The median follow-up was 52 months. OS and DFS were significantly worse in patients with an NLR above 2.84. Also, in patients with a dNLR value above 1.96 (p= 0.007). The were no relationship between PLR value, OS and DFS, and between gender and OS. OS was significantly lower in patients over 65 years of age (p< 0.001). These results suggested that haematological parameters can be used to estimate the prognosis of melanoma. These results suggested that haematological parameters can be used to estimate the prognosis of melanoma.

Objective: Fear of cancer recurrence (FCR) is an important psychological trauma associated with reduction in the quality of life, disruptions in the level of adjustment, emotional distress and anxiety. The purpose of the study was to evaluate the impact of patient–physician relationship on FCR. Methods: The study was designed as a multicentre survey study. The cancer survivors, who were under remission, were evaluated with structured questionnaires. Patient–physician relationship (PPR) scale in which higher scores indicate better relationship and FCR inventory was used. Results: Between January and April 2019, 1,580 patients were evaluated. The median age was 57.0 (19–88), and 66% were female. There was high level of FCR scores in 51% of participants. There was a negative correlation between PPR and FCR scores (r = −.134, p

Patients followed up with a cancer diagnosis must be well-informed about cancer to be able to cope with it. Besides, informing the relatives of the cancer patients who are also experiencing the same process about the diagnosis and follow-up period of cancer is highly important. In the current study, it was aimed to evaluate the information sources about cancer which are referred to by relatives of cancer patients. Three hundred ninety-one cancer patient relatives were included in medical oncology clinic between May 1 and June 30, 2015. A questionnaire was applied to the participants, comprising 12 questions to elicit demographic information and 11 questions about the information sources to which they referred. The study included 183 female and 208 male participants with amean age of 47.9 +/- 13.6 years. While the oncologists were the primary information sources referred to by 87%, the Internet was the second most preferred information source by 72%. The websites most frequently referred were the official websites (70%), the websites of oncology associations (53%), and social networks and forums (32%). The primary factors affecting the Internet preference were age, education level, income level, and place of residence. The Internet was the second most referred information source about cancer by family caregivers following oncologists. Therefore, it is of crucial importance that physicians inform patients and their relatives comprehensively as well as guiding them to correct and reliable information sources.

Purpose: The study aimed to retest the reliability and validity of the European Organization for Research and Treatment of Cancer-Core Quality of Life-15 Items Questionnaire for Palliative Care (EQRTC QLQ-C15-PAL) for the Turkish society and examine the influencing factors. Methods: The study was conducted in cancer patients who applied palliative treatment in the Dokuz Eylul University Oncology Institute Medical Oncology Division between May of 2014 and January of 2015. The demographic data collection form, performance status, and the EQRTC QLQ-C15-PAL scale were employed in order to gather data. Results: A total of 164 patients completed the study. The total Cronbach's alpha value for the scale was 0.794. The mean scores including the overall questionnaire, and subscales, which were calculated after two measurements conducted at an interval of three weeks, presented a statistically significant difference (p

The purpose of this study was to assess the feasibility and safety of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in elderly patients with peritoneal carcinomatosis of colorectal cancer.Patients who underwent curative complete CRS and HIPEC for peritoneal carcinomatosis of colorectal cancer with minimum follow-up of 24 months were included in the analysis. Charlson comorbidity index and ECOG performance status were used to evaluate preoperative condition. Patients were tiered into two groups according to age (65 and ≥65 years). Postoperative morbidity, mortality, recurrence, and overall survival were compared between groups.One-hundred patients were meeting the inclusion criteria. Median age was 56 years (ranging, 20-86). The origin of peritoneal carcinomatosis (PC) was colon in 77 and rectum in 23 patients. There were 31 patients in the elderly group. Mean hospital stay was 1711.8 and 16.814.3 days in young and elderly groups (p=0.937). In young patients, postoperative morbidity was seen in 26 (37.6%) patients versus 9 (29%) patients in elderly group (p=0.272). Mortality was higher in elderly group (n=4, 12.9%) than in the younger group (n=5, 7.2%), but the difference was not statistically significant (p=0.287). Median follow-up was 25 months (ranging, 2-112). Local and/or distant recurrence occurred in 30 (43.4%) patients in the young group and 9 (29%) patients in elderly group (p=0.169). Two-years disease-free survival was similar: 67.1% in the young and 74% in the elderly groups (p=0.713).CRS and HIPEC offer comparable oncologic outcome in meticulously selected medically-fit elderly patients without increased postoperative morbidity and mortality.

Symptom management for gastrointestinal (GI) cancers depends on the type of cancer, the stage, the presence and kind of systemic symptoms such as anorexia, early satiety nausea, dysgeusia and smell changes, and comorbidities. Symptoms occur early, particularly in esophageal, gastric, and pancreatic cancers. Clinicians should assess a patient’s symptom burden at the time of diagnosis using validated questionnaires. Symptoms appear to cluster rather than appear in a random fashion. A group of symptoms may help in cancer diagnosis, management, and prognostication. Certain symptom clusters negatively affect quality of life and influence treatment compliance of patients as well as add to caregiver burden. Assessing evolving symptoms with follow-up and early palliative intervention can improve quality of life for a cancer patient.

The aim of this study was to evaluate the effects of education on the upper extremity functions of patients with lymphedema (LE) after breast cancer treatments.Thirty-eight patients with LE after breast cancer treatments participated in the study. The patients were separated into two groups. Group 1 (n = 19) was educated about the causes and symptoms of LE and the methods for minimizing complications from LE, such as skin care, changes that must be made in daily life activities, exercises, and protective clothing. Group 2 (n = 19) was treated through standard means (surgical, chemotherapy, radiotherapy). A universal goniometer was used to assess the range of motion of the upper extremity of the patients. The Disabilities of the Arm, Shoulder and Hand questionnaire (DASH) and the Shoulder Pain and Disability Index (SPADI) were used to assess shoulder function. The measures were carried out once by the same physiotherapist. The chi-square and Mann-Whitney U tests were used to analyze the data.Group 1, educated about LE, performed better than the other group in shoulder flexion range. When shoulder abduction, internal-external rotation, and elbow flexion motions were compared by using the DASH and SPADI, no significant difference was observed between the groups (p 0.05). However, when shoulder function was compared, Group 1 was better. There was no significant difference between the groups when the severity of LE was compared.This study underscores the need to develop and implement strategies for LE prevention and education for all breast cancer patients.

WOS: 000380677200011 PubMed ID: 27039206 Persistent postmastectomy pain syndrome (PMPS) is one of the most important disturbing symptoms. Posttraumatic stress disorder (PTSD) is an anxiety disorder which is characterized by reactions to reminders of the trauma that has been experienced. The purpose of this study is to evaluate the predictors of PMPS and PTSD in Turkish breast cancer survivors and the correlation between PMPS and PTSD. The study is designed as a multicenter survey study. Breast cancer patients in remission were evaluated. Patients were evaluated with structured questionnaires to assess the PMPS and clinical parameters associated with it. The Turkish version of the posttraumatic stress disorder checklist-civilian version (PCL-C) was used. Between February 2015 and October 2015, 614 breast cancer survivors in outpatient clinics were evaluated. The incidence of PMPS documented is 45.1 %. In the multivariate analysis low income, presence of PTSD and < 46 months after surgery were associated with increased risk of PMPS. PTSD was documented in 75 %, and the mean PCL-C score was 32.4 +/- 11.1. PMPS and being married at the time of the evaluation were linked with PTSD. It is the first data about the association between PMPS and PTSD. The clinicians should be aware of PMPS and PTSD in breast cancer survivors.

Background: Complex decongestive physiotherapy (CDP) is an effective treatment for patients with breast cancer-related lymphedema (BCRL). Bandaging is an important component of CDP. Although the literature suggests that bandages must be kept on for about 24 hours, some patients cannot tolerate keeping them on for this length of time. Also, it has been observed that limb volume decreased in patients who did not keep bandages on for 24 hours in clinical trials. But there is no evidence that this reduction in time is statistically significant. Our purpose was to compare the effectiveness of bandage compliance for a longer or a shorter period on limb volume in patients with BCRL. Methods and Results: We retroprospectively reviewed the medical records of 39 patients who received CDP. Twenty-eight eligible patients were divided into two groups, group 1 (n=18) and group 2 (n=10), according to the average number of hours of bandage compliance, which was 13-24 and 7-12 hours, respectively. The primary outcome was the change in limb volume between groups. The values for the limb volumes showed a statistically significant decrease in both groups. There was no significant difference in volume reduction between the groups. Conclusion: This study shows that keeping bandages on for between about 12 and 24 hours has the same effect on patients with BCRL as receiving CDP.

346 Background: Although clinical efficacy of gemcitabine in combination with nabpaclitaxel has been shown to be superior to single agent gemcitabine in a randomize phase 3 trial, data are lacking on the quality of life of this combination regimen as first-line therapy in patients with unresectable locally advanced or metastatic pancreatic adenocarcinoma. Methods: We randomly assigned 125 patients with an Eastern Cooperative Oncology Group performance status score of 0 or 1 to receive gemcitabine, 1000 mg/m2 plus nabpaclitaxel 125 mg/m2 or gemcitabine at a dose of 1000 mg per square meter weekly for 7 of 8 weeks and then weekly for 3 of 4 weeks. Treatment continued until disease progression or unacceptable toxicity. The primary end point was 3-months deterioration-free rate (percentage of patients free from definitive deterioration) and quality of life of patients. Results: The median overall survival was 9.92 months in the gemcitabine plus nabpaclitaxel group as compared with 5.95 months in the gemcitabine group (hazard ratio for death, 0.642, 95% confidence interval, 0.422 to 0.866; p < 0.038). Median progression-free survival was 6.28 months in the combination group and 3.22 months in the gemcitabine group (hazard ratio for disease progression, 0.582; 95% CI, 0.391 to 0.866; p < 0.008). The objective response rate was 37.1% in the combination group versus 23.7% in the gemcitabine group (p < 0.009). Median time to deterioration was 3.68 months in the gemcitabine arm versus 5.36 months in the combination arm. More data on quality of life will be presented. Conclusions: As compared with gemcitabine, gemcitabine plus nabpaclitaxel was associated with an overall and progressive free survival advantage, with increased response rate, without increasing toxicity and deterioration of quality of life. Gemcitabine and nabpaclitaxel combination regimen with this form is a preferable option for the treatment of patients with advanced pancreatic cancer Clinical trial information: EudraCT: 2013-004180-32.

Cancer is one of the most common causes of death all over the World (Rahib et al. in Cancer Res 74(11):2913–2921, 2014; Silbermann et al. in Ann Oncol 23(Suppl 3):iii15–iii28, 2012). It is crucial to diagnose this disease early by effective screening methods and also it is very important to acknowledge the community on various aspects of this disease such as the treatment methods and palliative care. Not only the oncologists but every medical doctor should be educated well in dealing with cancer patients. Previous studies suggested various opinions on the level of oncology education in medical schools (Pavlidis et al. in Ann Oncol 16(5):840–841, 2005). In this study, the perspectives of medical students on cancer, its treatment, palliative care, and the oncologists were analyzed in relation to their educational status. A multicenter survey analysis was performed on a total of 4224 medical school students that accepted to enter this study in Turkey. After the questions about the demographical characteristics of the students, their perspectives on the definition, diagnosis, screening, and treatment methods of cancer and their way of understanding metastatic disease as well as palliative care were analyzed. The questionnaire includes questions with answers and a scoring system of Likert type 5 (absolutely disagree = 1, completely agree = 5). In the last part of the questionnaire, there were some words to detect what the words “cancer” and “oncologist” meant for the students. The participant students were analyzed in two study groups; “group 1” (n = 1.255) were phases I and II students that had never attended an oncology lesson, and “group 2” (n = 2.969) were phases III to VI students that had attended oncology lessons in the medical school. SPSS v17 was used for the database and statistical analyses. A value of p < 0.05 was noted as statistically significant. Group 1 defined cancer as a contagious disease (p = 0.00025), they believed that early diagnosis was never possible (p = 0.042), all people with a diagnosis of cancer would certainly die (p = 0.044), and chemotherapy was not successful in a metastatic disease (p = 0.003) as compared to group 2. The rate of the students that believed gastric cancer screening was a part of the national screening policy was significantly more in group 1 than in group 2 (p = 0.00014). Group 2 had a higher anxiety level for themselves or their family members to become a cancer patient. Most of the students in both groups defined medical oncologists as warriors (57% in group 1 and 40% in group 2; p = 0.097), and cancer was reminding them of “death” (54% in group 1 and 48% in group 2; p = 0.102). This study suggested that oncology education was useful for the students’ understanding of cancer and related issues; however, the level of oncology education should be improved in medical schools in Turkey. This would be helpful for medical doctors to cope with many aspects of cancer as a major health care problem in this country. © 2018, American Association for Cancer Education.

Insomnia, poor sleep quality and short sleep durations are the most common problems seen in cancer patients. More studies are needed about sleep disorders in cancer patients. In our study, we aimed to investigate the prevalence of sleep disorders and the impact of these problems on the quality of life in cancer patients. Pittsburgh Sleep Quality Index (PSQI) was given to a total of 314 patients. The psychometric evaluation of the Turkish version of PSQI in cancer patients revealed that 127 (40.4%) patients had global PSQI scores >5, indicating poor sleep quality. There was no statistically significant relationship between PSQI scores and sexuality, marital status, cancer stage and chemotherapy type (P > 0.05); while the patients with bone and visceral metastasis had much lower PSQI scores (P = 0.006). Patients with Eastern Cooperative Oncology Group performance scores of 3 or more had also significantly lower PSQI scores (P = 0.02). In conclusion, PSQI questionnaire may be used to evaluate the sleep disorders in cancer patients. Consistent use of multi-item measures such as PSQI with established reliability and validity would improve our understanding of difficulties experienced by cancer patients with chronic insomnia.

OBJECTIVE The aim of the present study was to compare the effects of clinical Pilates exercises with those of the standard lymphedema exercises on lymphedema developing after breast cancer treatment. MATERIALS AND METHODS The study comprised 60 female patients with a mean age of 53.2±7.7 years who developed lymphedema after having breast cancer treatment. The patients were randomized into two groups: the clinical Pilates exercise group (n=30), and the control group (n=30). Before, and at the 8th week of treatment, the following parameters were measured: the severity of lymphedema, limb circumferences, body image using the Social Appearance Anxiety Scale, quality of life with the European Organization for Research and Treatment of Cancer (EORTC) quality of life questionnaire (QLQ-BR23), and upper extremity function using the Disabilities of the Arm, Shoulder and Hand (DASH) outcome measure. Both groups performed one-hour exercises three days a week for 8 weeks. RESULTS After treatment, the symptoms recovered significantly in both groups. Reductions in the severity of lymphedema, improvements in the social appearance anxiety scale scores, quality of life scores, and upper extremity functions scores in the clinical Pilates exercise group were greater than those in the control group. Clinical Pilates exercises were determined to be more effective on the symptoms of patients with lymphedema than were standard lymphedema exercises. CONCLUSIONS Clinical Pilates exercises could be considered a safe model and would contribute to treatment programs.

Aim of the study: There is little known about any change in postural balance caused by asymmetrical volume increase due to unilateral upper extremity lymphedema in patients who underwent breast surgery. The aim of this study was to determine whether there is a change in postural balance by measuring postural sway velocity (PSV), center of gravity (CoG) displacement and directional control (DCL) in patients with unilateral upper extremity lymphedema in breast cancer survivors. Material and methods: Eighteen females 38-60 (M = 53) years old diagnosed with upper extremity lymphedema due to breast cancer surgery, and 18 healthy females with similar ages (M = 52.5) were assessed using the Balance Master system (Neuro Com, Clackamas, USA). Unilateral stance (US) and bilateral stance (BS) tests in eyes open and closed conditions and the limit of stability (LOS) test were applied to quantify postural sway velocity (PSV), CoG displacement, and directional control (DCL). Results: The lymphedema group showed a significant increase in PSV in the US test on the ipsilateral leg with eyes open (p = 0.02) and eyes closed (p = 0.005) as well as on the contralateral leg with eyes open (p = 0.004) and eyes closed (p = 0.0001). Average displacement and position of the CoG were 25% of LOS (p = 0.0001) towards the lymphedema side and 60.6 degrees respectively. DCL in the lymphedema group was significantly lower in forward (p = 0.0001), back (p = 0.003), ipsilateral (p = 0.002), and contralateral (p = 0.03) directions. Conclusions: These findings suggest that unilateral upper extremity lymphedema may have challenging effects on postural balance.

Background: Surgical excision constitutes an important part of the treatment of local advanced malignant melanoma. Due to the high recurrence risk, adjuvant high-dose interferon therapy is still the only therapy used in stage IIB and III high-risk melanoma patients. Methods: One hundred two high-risk malignant melanoma patients who received high-dose interferon-α-2b therapy were evaluated retrospectively. The clinicopathological features, survival times, and prognostic factors of the patients were determined. Results: The median disease-free and overall survival times were 25.2 and 60.8 months, respectively. Our findings revealed that male gender, advanced disease stage, lymph node involvement, lymphatic invasion, the presence of ulceration, and a high Clark level were significant negative prognostic factors. Conclusion: In light of the favorable survival results obtained in this study, high-dose interferon treatment as adjuvant therapy for high-risk melanoma is still an efficient treatment and its possible side effects can be prevented by taking the necessary precautions.

Introduction. We discuss a rare gastrointestinal stromal tumor (GIST) case detected at the 10th postpartum week and we want to pay attention to the challenges and improvements in the diagnosis, surgery, chemotherapy, and follow-up of this rare tumor accompanied with the review of the current literature. Case Presentation. A 32-year-old multiparous woman presented with abdominal swelling 10 weeks after her second vaginal birth. Abdominal examination revealed a mass starting from the pelvic level and extending to the right upper quadrant. Radiological examinations showed a solid, multiloculated, and hypervascular mass starting from the pelvis and extending to the transverse colon. En bloc mass with a 20 cm jejunal segment resection and a left pelvic side wall peritonectomy with omentectomy was performed. The pathologic examination revealed a high-risk GIST which originated from the jejunum and disseminated to the peritoneum. The patient has been given imatinib 400 mg/day since then. She did not reveal any progression during the 15-month follow-up postoperatively. Conclusion. GIST tumors are rare and there is not sufficient information in the literature regarding its management. In this patient having high risk GIST and GIST sarcomatosis we successfully treated the patient by surgery and adjuvant imatinib chemotherapy.

e21702Background: Persistent postmastectomy pain syndrome (PMPS) is one of the most important disturbing symptoms. Posttraumatic stress disorder (PTSD) is an anxiety disorder which is characterized...

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.

A 63-year-old man was admitted to our hospital with 2 months history of dysphagia. Endoscopic examination revealed an ulserovegetan tumor starting from distal esophagus and extending to the cardia. Pathological examination of the biopsy revealed an epithelial malignant tumor without further classification. The patient underwent a surgery following neo-adjuvant chemotherapy with oxaliplatin, 5-fluorouracil and leucoverin (FOLFOX) regimen. Postoperative pathological analyses showed high grade EBV-associated lymphoepithelioma-like carcinoma of the gastroesophagial junction and stomach. After surgery, we planned to administered 6 cycles of FOLFOX regimen as an adjuvant treatment. Lymphoepithelioma-like gastric carcinoma is a rare type of gastric carcinoma and has distinct clinic-pathologic characteristics, including male predominance, preferential location in the gastric cardia, lymphocytic infiltration, a lower frequency of lymph node metastases and more favorable prognosis. Surgical resection is the most effective treatment modality. Chemotherapy may be considered for patients who have high risk factors.

To evaluate cancer-related fatigue (CRF) by objective measurements to determine if CRF is a more centrally or peripherally mediated disorder, cancer patients and matched noncancer controls completed a Brief Fatigue Inventory (BFI) and underwent neuromuscular testing. Cancer patients had fatigue measured by the BFI, were off chemotherapy and radiation (for more than four weeks), had a hemoglobin level higher than 10 g/dL, and were neither receiving antidepressants nor were depressed on a screening question. The controls were screened for depression and matched by age, gender, and body mass index. Neuromuscular testing involved a sustained submaximal elbow flexion contraction (SC) at 30% maximal level (30% maximum elbow flexion force). Endurance time (ET) was measured from the beginning of the SC to the time when participants could not maintain the SC. Evoked twitch force (TF), a measure of muscle fatigue, and compound action potential (M-wave), an assessment of neuromuscular-junction transmission were performed during the SC. Compared with controls, the CRF group had a higher BFI score (P0.001), a shorter ET (P0.001), and a greater TF with the SC (CRFcontrols, P0.05). This indicated less muscle fatigue. There was a greater TF (P0.05) at the end of the SC, indicating greater central fatigue, in the CRF group, which failed to recruit muscle (to continue the SC), as well as the controls. M-Wave amplitude was lower in the CRF group than in the controls (P0.01), indicating impaired neuromuscular junction conduction with CRF unrelated to central fatigue (M-wave amplitude did not change with SC). These data demonstrate that CRF patients exhibited greater central fatigue, indicated by shorter ET and less voluntary muscle recruitment during an SC relative to controls.

Purpose: Burnout is associated with decreased job performance and commitment, predicts stress-related health problems, and low career satisfaction. The specific objectives in our study were to assess the levels of burnout and to investigate the interrelationships between demographic characteristics and burnout health-care professionals working with cancer patients in Turkey. Methods: A questionnaire-based study was conducted in 77 physicians and 56 nurses working in an oncology clinic at the university hospital. We used quantitative survey to assess burnout levels in participants as well as sociodemographic variables. Data were collected using a Turkish version of the Maslach Burnout Inventory (MBI). Results: Nurses had significantly higher scores of emotional exhaustion (EE) when compared with the physicians, but no significant difference was found between two groups regarding other burnout components. Significant correlations were found in three different components of the MBI, as well as between each component, age and work experience in nurses and physicians. There were statistical significant differences for each of MBI subscales according to age groups in physicians. EE and depersonalization (D) were significantly higher in the ⩽29 years of age group than in the older age groups, while personal accomplishment (PA) score was significantly lower in this age group. EE, D, PA were significantly higher in single physicians compared with married physicians. Conclusions: Low level of PA was relatively high among Turkish physicians and nurses working in oncology department compared with previous studies. Younger and single physicians had higher burnout levels compared with older and married ones. Copyright © 2008 John Wiley & Sons Ltd.

The aim of the present study is to investigate anxiety and depression levels and quality of life of Turkish breast cancer patients and their husbands with Beck depression, STAI scoring system, and EORTC-QLQ-C30 quality of life scale. Fifty-five patients with breast cancer undergoing chemotherapy who applied to Dokuz Eylul University Faculty of Medicine, Department of Oncology, and their husbands were included in this study. The series of forms including the questions regarding the demographic characteristics of the patient, Beck Depression Inventory (BDI), the State-Trait Anxiety Inventory (STAI), and EORTC-QLQ-C30 (version 3) were completed during face-to-face interviews by trained interviewers for determination of the psychological status and quality of life of the patients. The mean Beck depression scores of patients and their husbands were 13 +/- A 9.3 (range 2-46) and 7.9 +/- A 5.7 (range 0-27) (P = 0.001). The mean STAI scores of patients and their husbands were 44.9 +/- A 8.7 (range 20-58) and 41.7 +/- A 8.0 (range 26-59) (P = 0.09).Twenty-nine percent of the patients and 5.4% of the husbands (Beck Depression scores a parts per thousand yen17 points) were determined as depressive. It was determined that the EORTC-QLQ C30 physical and social function scales of the patients were significantly lower than their husbands. The difference of global quality of life scores and other function scales (role, cognitive, emotional function scales) between patients and their husbands were not significant. It was found that depression of breast cancer patients were significantly higher than their husbands. But there was no significant difference between the EORTC-QLQ C30 global quality of life scores and STAI scores of the breast cancer patients and their husbands.

e202 Methods: We present a series of 4 patients diagnosed with plasma cell leukemia (PCL) between 2009 and 2014. The LCP was diagnosed in these cytomorphology and by study of peripheral blood cytometry. 25% had LCP Primary BJ Lambda MM and 75% LPC Secondary. The therapeutic use in our patients was diverse and personalized; patients with Primary LPC receiving schemes with Bortezomib (25%) plus autologous stem cell transplantation and patients with Secundary LPC Dexamethasone alone (75%). Results: Distribution was 3 males and 1 female. The average age of diagnosis was 61y.o(51-72). All present elevated B2-microglobulin and LDH.75% of our patients were creatinine levels >2 mg/dl. Secundary LCP had all thrombocytopenia and Hb 20% in all cases, being much higher in primary LCP(60% CP). Patients with secondary LCP presented in 66%lytic lesions and 33%splenomegaly; and in the case of LCP primary splenomegaly, paravertebral plasmacytoma and infiltration with CP skin, testicular and evidenced pleural effusion. Mortality was 100% in the first 20days of diagnosis in the secondary LCP. Early treatment in primary LCP was established with Bortezomib-dexamethasone reaching RP, then treated with Bortezomib-IFE and ASCT was conducted reaching RC, with early relapse after 90days and DTPACE used as rescue no response, exitus at 11months after diagnosis. Conclusion: LCP prognosis in patients of our hospital is similar to those of the literature review, to be unfavorable with average survival 6months.-Today confirmed that curative treatment is not known, but treatment must begin immediately to achieve rapid control of disease in an effort to minimize the risk of early death with multidrug regimens based on Bortezomib intensified with ASCT when the age and general condition of the patient permits 15th International Myeloma Workshop, September 23-26, 2015 PO-209 Quality of Life in Multiple Myeloma: Validation of the Turkish Version of the Qlq-My20 Instrument O.G. Sevindik, I. Alacacioglu, K.B. Payzin, T. Yavuzsen, F.G. Ozdemirkiran, T. Yildirim, S.M. Solmaz, O. Piskin, M.A. Ozcan, G.H. Ozsan, F. Demirkan Department of Hematology, Dokuz Eylul University; Department of Hematology, Izmir Ataturk Training Hospital; Department of Medical Oncology; Department of Internal Medicine, Dokuz Eylul University

Purpose The aim of this study is to determine the predictors of functional capacity and explore the relationship between functionalcapacity,performancestatus,fatigue,qualityoflife, anxiety, and depression in colorectal cancer (CRC) patients. Methods Forty-two patients diagnosed as stage II–III CRC according to tumor, node, metastasis (TNM) classification were included the study. Functional capacity, performance status, fatigue, quality of life, anxiety, and depression of CRC patients were assessed using six-minute walk distance (6MWD) in the six-minute walk test (6MWT), Eastern Cooperative Oncology Group Performance Status (ECOG-PS), Brief Fatigue Inventory (BFI),Functional AssessmentofCancer Therapy-Colorectal (FACT-C), and Hospital Anxiety and Depression Scale (HADS), respectively. A multiple linear regression model was used to identify independent predictors of functional capacity. Results The six-minute walk distance (6MWD) was intermediately and negatively correlated with ECOG-PS score (p= 0.001, r=�0.415), BFI-impact of fatigue on daily functioning score (p=0.013, r=�0.379), and age (p=0.040, r=�0.319). An intermediate and positive correlation was found between 6MWD and FACT-C score (p=0.016,r=0.369). The multiple regression analysis revealed that only ECOG-PS score was significant and independent predictor of the 6MWD, accounted for 34.8 % of the variance. Conclusion Performance status was found to be the only significant predictor of functional capacity in this study. Assessing performance status may have an essential role in order to predict functional capacity in CRC patients. Future studies that include a larger sample size would more clearly elucidate the predictors and relationships of functional capacity.