Journal d'oncologie intégrative

Background: Healthcare-associated infections (HAIs) consist of a major cause of morbidity and mortality among patients with hematologic malignancies, resulting in high length of stay and healthcare costs. The aim of this study was to assess the HAIs rates in adult hematology-oncology patients.
Patients and Methods: A prospective surveillance study was performed in a hematology-oncology unit in Athens, Greece. All patients who remained for ≥ 48 hours were studied. A standardized surveillance system based on the National Healthcare Safety Network of the Centers for Disease Control and Prevention was implemented.
Results: During 1,156 patient-days, 16 of 85 patients acquired 20 HAIs resulting in an overall rate of 18.8% of patients or 17.3 HAIs per 1,000 patient-days. FUO rate was 42.5 per 1,000 patient-days with neutropenia. Most of HAIs was laboratory confirmed (80%) than clinically documented (20%). Central line-associated bloodstream infection was the most commonly encountered type of infection, accounting for 25% of all HAIs, followed by soft tissue infections (20%). The rates of neutropenia, blood transfusion and presence of central venous catheter were significantly greater among patients with HAI, compared with patients without HAI (p<0.05). The crude mortality rate for patients with and without HAI was 12.5% and 2.9%, respectively (p=0.234).The mean length of stay was statistically longer for patients with HAI compared with patients without HAI (29.6 ± 28.5 vs. 9.8 ± 6.8 days, p<0.001). Gram-negative bacteria were the most prevalent pathogens (73.3%).
Conclusions: Our findings highlight the problem of HAIs in hematology-oncology patients and emphasize the importance of a comprehensive education program focused on evidence-based approaches for all healthcare workers and continuing active surveillance program, which will contribute to reducing the consequences of HAIs and improving patient safety.

Glioblastoma multiforme is a pathology that is poorly treatable and tends towards recurrence. If surgically unresectable, at least without macroscopically visible residue, the prognosis is severe. Here is the case of a 60-yearold woman suffering from recurrent glioblastoma who comes to my observation with no therapeutic options and treated with a combination of antiangiogenic drug, RF capacitive hyperthermia and herbal medicine, earns an acceptable quality of life and survival prolongation of six months.

The neck is anatomically complex, and incisions in this region commonly result in cosmetic complaints. Surgeons have worked to reduce the size of incisions used in the neck region through the use of ancillary instruments. One of these instruments, the Da Vinci Robotic System, is able to reach the neck using a wide variety of approaches. These approaches were first pioneered in thyroid and parathyroid surgeries. The most commonly used approach in robotic parathyroid surgery is transaxillary. We conducted a literature search to analyze the areas of use, advantages, and disadvantages of robotic transaxillary parathyroid surgery. The transaxillary approach does not create a scar in the neck region and significantly improves cosmetic outcomes for the patient, compared with conventional parathyroid surgery.

In selected patients diagnosed with Breast Cancer (BC), adjuvant chemotherapy might reduce local and systemic recurrence risk, as well as cancer death rate. The combination of Docetaxel and Cyclophosphamide (TC) is a wellrecognized effective adjuvant chemotherapy regimen. Nonetheless, a considerable high rate of febrile neutropenia (FN) is associated with this regimen. We sought to investigate hematologic toxicity associated with adjuvant TC in a non-selected, “real world” cohort of BC patients.

Methods: We reviewed the electronic medical records of patients who presented to the Oncology Center from Hospital Sírio-Libanês (HSL) and Instituto do Câncer do Estado de Sao Paulo (ICESP). Patients included in the analysis received adjuvant chemotherapy with TC regimen after definitive breast surgery.

Results: 95 patients with were included in our analysis. Median age was 55.5 years. All patients had a good performance status (either ECOG 0 or 1), and the great majority had no comorbidities. Most patients received 4 cycles of chemotherapy (80%). Data on granulocyte colony stimulating factor (G-CSF) administration was available in 85 patients from our cohort. G-CSF was used as primary prophylaxis in 31 patients, and as secondary prophylaxis in 13 patients, following a prior episode of febrile neutropenia. Overall, fifteen women (15.8%) had a documented FN episode. Among women who received G-CSF as primary prophylaxis, the rate of FN was 6.45% (2 patients). In contrast, among patients who did not receive primary prophylaxis with G-CSF, FN rate was considerably higher, namely 24.07% (13 patients). Patients who received primary prophylaxis with G-CSF had a statistically significant lower risk of experiencing a FN episode (p=0.049).

Conclusion: Febrile Neutropenia rate in this group of non-selected BC patients was higher than previous reported on randomized controlled trials that evaluated adjuvant TC regimen in the same dosing and schedule as used in our cohort. Primary prophylaxis with G-CSF was associated with a statistically significant lower risk of FN and should be considered in the management of patients who receive this chemotherapy combination.