Oncology-Led Early Identification of Nutritional Risk: A Pragmatic, Evidence-Based Protocol (PRONTO).

Nutritional issues, including malnutrition, low muscle mass, sarcopenia (i.e., low muscle mass and strength), and cachexia (i.e., weight loss characterized by a continuous decline in skeletal muscle mass, with or without fat loss), are commonly experienced by patients with cancer at all stages of disease. Cancer cachexia may be associated with poor nutritional status and can compromise a patient's ability to tolerate antineoplastic therapy, increase the likelihood of post-surgical complications, and impact long-term outcomes including survival, quality of life, and function. One of the primary nutritional problems these patients experience is malnutrition, of which muscle depletion represents a clinically relevant feature. There have been recent calls for nutritional screening, assessment, treatment, and monitoring as a consistent component of care for all patients diagnosed with cancer. To achieve this, there is a need for a standardized approach to enable oncologists to identify patients commencing and undergoing antineoplastic therapy who are or who may be at risk of malnutrition and/or muscle depletion. This approach should not replace existing tools used in the dietitian's role, but rather give the oncologist a simple nutritional protocol for optimization of the patient care pathway where this is needed. Given the considerable time constraints in day-to-day oncology practice, any such approach must be simple and quick to implement so that oncologists can flag individual patients for further evaluation and follow-up with appropriate members of the multidisciplinary care team. To enable the rapid and routine identification of patients with or at risk of malnutrition and/or muscle depletion, an expert panel of nutrition specialists and practicing oncologists developed the PROtocol for NuTritional risk in Oncology (PRONTO). The protocol enables the rapid identification of patients with or at risk of malnutrition and/or muscle depletion and provides guidance on next steps. The protocol is adaptable to multiple settings and countries, which makes implementation feasible by oncologists and may optimize patient outcomes. We advise the use of this protocol in countries/clinical scenarios where a specialized approach to nutrition assessment and care is not available.

The Determination of a Consensus Nutritional Approach for Cancer Patients in Spain Using the Delphi Methodology.

Malnutrition has a multifactorial origin and can be caused by cancer. This study determined the consensus of a panel of experts on the nutritional approach for cancer patients in Spain using a multidisciplinary approach. Using the Delphi methodology, a 74-question questionnaire was prepared and sent to 46 experts. The areas of knowledge addressed were the nutritional status of the cancer patient, nutritional screening, nutritional therapy, patient referral, and multidisciplinary care. A total of 91.7% of the experts agreed with the questions posed on nutritional status, 60.0% with those on nutritional screening, 76.7% with those on nutritional therapy, and the entire panel of experts agreed with the questions posed on patient referral and multidisciplinary care. The experts agreed upon a high prevalence of malnutrition among cancer patients in Spain. Unlike medical and radiation oncologists, medical nutrition specialists believe that body composition assessment should not be carried out in all types of cancer patients during nutritional screening and that interventions can be conducted outside the oncology clinic. In general, it is recommended that nursing staff routinely perform nutritional screening before starting cancer treatment. It is necessary to develop a multidisciplinary action protocol that includes nutritional and/or sarcopenia screening.

High-Flux Thin Film Composite PIM-1 Membranes for Butanol Recovery: Experimental Study and Process Simulations.

Thin film composite (TFC) membranes of the prototypical polymer of intrinsic microporosity (PIM-1) have been prepared by dip-coating on a highly porous electrospun polyvinylidene fluoride (PVDF) nanofibrous support. Prior to coating, the support was impregnated in a non-solvent to avoid the penetration of PIM-1 inside the PVDF network. Different non-solvents were considered and the results were compared with those of the dry support. When applied for the separation of n-butanol/water mixtures by pervaporation (PV), the developed membranes exhibited very high permeate fluxes, in the range of 16.1-35.4 kg m-2 h-1, with an acceptable n-butanol/water separation factor of about 8. The PV separation index (PSI) of the prepared membranes is around 115, which is among the highest PSI values that have been reported so far. Hybrid PV-distillation systems have been designed and modeled in Aspen HYSYS using Aspen Custom Modeler for setting up the PIM-1 TFC and commercial PDMS membranes as a benchmark. The butanol recovery cost for the hybrid systems is compared with a conventional stand-alone distillation process used for n-butanol/water separation, and a 10% reduction in recovery cost was obtained.

Electrospun Nanostructured Membrane Engineering Using Reverse Osmosis Recycled Modules: Membrane Distillation Application.

As a consequence of the increase in reverse osmosis (RO) desalination plants, the number of discarded RO modules for 2020 was estimated to be 14.8 million annually. Currently, these discarded modules are disposed of in nearby landfills generating high volumes of waste. In order to extend their useful life, in this research study, we propose recycling and reusing the internal components of the discarded RO modules, membranes and spacers, in membrane engineering for membrane distillation (MD) technology. After passive cleaning with a sodium hypochlorite aqueous solution, these recycled components were reused as support for polyvinylidene fluoride nanofibrous membranes prepared by electrospinning technique. The prepared membranes were characterized by different techniques and, finally, tested in desalination of high saline solutions (brines) by direct contact membrane distillation (DCMD). The effect of the electrospinning time, which is the same as the thickness of the nanofibrous layer, was studied in order to optimize the permeate flux together with the salt rejection factor and to obtain robust membranes with stable DCMD desalination performance. When the recycled RO membrane or the permeate spacer were used as supports with 60 min electrospinning time, good permeate fluxes were achieved, 43.2 and 18.1 kg m-2 h-1, respectively; with very high salt rejection factors, greater than 99.99%. These results are reasonably competitive compared to other supported and unsupported MD nanofibrous membranes. In contrast, when using the feed spacer as support, inhomogeneous structures were observed on the electrospun nanofibrous layer due to the special characteristics of this spacer resulting in low salt rejection factors and mechanical properties of the electrospun nanofibrous membrane.

Treatment completion rates and toxicity of 5 fractions of adjuvant radiotherapy over one week in elderly breast cancer patients treated with lumpectomy.

BACKGROUND: Elderly patients are usually frail and cannot attend a prolonged radiotherapy course. Many of them undergo mastectomy to avoid adjuvant radiotherapy thinking that they are not going to complete at least 15 fractions. Many studies have suggested hypofractionated radiotherapy in 5 days. We would like to describe the treatment completion rates and toxicity of 5 fractions of 520 cGy delivered within one week in patients over 70 years old treated with tumorectomy. METHODS: Between June 2016 and May 2019 we have analyzed retrospectively 23 patients treated with lumpectomy plus 5 fractions adjuvant radiotherapy. All patients had negative SLNB and aged between 70 and 93 years old. After finishing the RT treatment, follow up was made at 1 month, 3 months, 6 months and a year. This follow up was based on an interview and physical examination. RESULTS: Independently of their age, the treatment completion rate was 100%. Every patient finished the whole treatment with no interruptions. Regarding cosmetic or toxicity outcomes within one year, there was only one patient with grade I radiation induced dermatitis and 2 patients with pruritus. CONCLUSIONS: Five fractions schedule within one week is well tolerated with no important severe side effects after one year. Elderly patients appreciate to make as short as possible the number of fractions, decreasing the number of days days they have to come to clinic, improving patient satisfaction and treatment completion rates.

Randomized Phase 2 Trial of a Novel Clonidine Mucoadhesive Buccal Tablet for the Amelioration of Oral Mucositis in Patients Treated With Concomitant Chemoradiation Therapy for Head and Neck Cancer.

PURPOSE: Oral mucositis (OM) is a frequent and painful sequela of concomitant chemoradiation (CRT) used for the treatment of head and neck cancer (HNC) for which there is no effective intervention. This randomized, placebo-controlled study evaluated the efficacy of a novel, mucoadhesive topical tablet formulation of clonidine in mitigating CRT-induced OM in patients with HNC. METHODS AND MATERIALS: Patients with HNC undergoing adjuvant radiation therapy (60-66 Gy; 5 × 1.8-2.2 Gy/wk) with concomitant platinum-based chemotherapy received daily local clonidine at 50 µg (n = 56), 100 µg (n = 65), or placebo (n = 62) via a topical mucobuccal tablet starting 1 to 3 days before and continuing during treatment. The primary endpoint was the incidence of severe OM (severe OM [SOM], World Health Organization grade 3/4). RESULTS: SOM developed in 45% versus 60% (P = .06) of patients treated with clonidine compared with placebo and occurred for the first time at 60 Gy as opposed to 48 Gy (median; hazard ratio, 0.75 [95% confidence interval, 0.484-1.175], P = .21); median time to onset was 45 versus 36 days. Opioid analgesic use, mean patient-reported mouth and throat soreness, and CRT compliance were not significantly different between treatment arms. Adverse events were reported in 90.8% versus 98.4%, nausea in 49.6% versus 71.0%, dysphagia in 32.8% versus 48.4%, and reversible hypotension in 6.7% versus 1.6% of patients on clonidine versus placebo, respectively. CONCLUSIONS: Although the primary endpoint was not met, the positive trends of OM-associated outcomes suggest that the novel mucoadhesive tablet delivery of clonidine might favorably affect the course and severity of CRT-induced SOM and support further evaluation.

Dolor irruptivo y calidad de vida: estudio comparativo de la percepción por parte de los médicos y los pacientes oncológicos / Breakthrough pain and quality of life: A comparative study of the perception by physicians and cancer patients

OBJETIVO: El propósito de este estudio fue investigar el grado de concordancia entre pacientes que sufren dolor irruptivo oncológico y los médicos que los tratan en la percepción del dolor y la calidad de vida (CdV). MÉTODO: Se llevó a cabo un estudio multicéntrico, transversal y observacional. La información sobre el dolor y la CdV se recogió mediante las herramientas Brief Pain Inventory (BPI) y EuroQoL five-dimensional questionnaire (EQ-5D), ambas completadas por los médicos y los pacientes. También se recogieron los datos sociodemográficos y clínicos, incluyendo la puntuación de la capacidad funcional ECOG. Para el análisis de la concordancia en las percepciones de la CdV y el dolor entre médicos y pacientes se calcularon los coeficientes de correlación intraclase y el estadístico κ ponderado. Resultado: Un total de 129 médicos y 472 pacientes participaron en el estudio. Casi todos los doctores (98,4%) tenían experiencia previa en el manejo de pacientes con dolor irruptivo oncológico. Con relación a la intensidad de dolor y al impacto de este en la vida cotidiana, los coeficientes de correlación intraclase (todos por encima de 0,84) indicaron que había un alto grado de acuerdo entre las valoraciones de los médicos y la de los pacientes. Para la CdV, se observó una buena concordancia entre médicos y pacientes, con estadísticos κ desde 0,61 (ítem de ansiedad/depresión) a 0,75 (ítem de actividades de la vida diaria). La declaración del dolor experimentado por los pacientes fue de 8 para la intensidad máxima y de 5 para la intensidad media. CONCLUSIONES: En este estudio de práctica clínica habitual, los médicos participantes eran razonablemente conocedores del nivel de funcionalidad y bienestar de sus pacientes, siendo la percepción del componente psicológico (ansiedad/depresión) de la CdV la menos concordante. Estos hallazgos ayudan a conocer mejor la prevalencia e intensidad del dolor, su interferencia con las actividades de la vida diaria y la CdV en pacientes oncológicos con dolor irruptivo oncológico, un paso esencial para mejorar el manejo del dolor asociado a cáncer

OBJECTIVE: To analyse the agreement on perceptions of pain and quality of life (QoL) between patients with cancer-related breakthrough pain and their treating physicians. METHOD: A multicentre, cross-sectional, observational study was performed. Pain and QoL information was collected using the Brief Pain Inventory and the EuroQoL five-dimensional questionnaire completed by physicians and PATIENTS: Agreement between patient- and physician-perceived QoL and pain scores was evaluated using intraclass correlation coefficients and weighted κ statistics. RESULTS: A total of 129 physicians and 472 patients participated in the study. Almost all doctors (98.4%) had previous experience in managing patients with cancer breakthrough pain. For pain intensity and impact of pain on daily life, intraclass correlation coefficients (all exceeding 0.84) indicated that there was strong agreement between physician and patient assessments. For QoL, good concordance was found between patients and physicians, with weighted κ statistic ranging from 0.61 (anxiety/depression item) to 0.75 (daily activities item). Patient pain reports were 8.0 for the worst pain, and 5.0 for mean pain. CONCLUSIONS: In this setting, physicians were reasonably aware of their patients' level of functioning and well-being, with gaps only in the psychological dimension (anxiety/depression) of QoL. These findings contribute to a better understanding of pain prevalence and intensity, interference of pain with daily activities, and QoL in cancer patients with breakthrough pain, and are an essential step towards improving cancer pain management