An Acute Oncology Service (AOS) is paramount to providing timely and improved pathways of care for patients who are admitted to hospital with cancer-related problems or suspected cancer.To establish an AOS pilot study to decide how best to implement such a service locally.The AOS, which included collaboration between the oncology and palliative care teams at the Northern General Hospital in Sheffield, UK, ensured that the majority of oncology patients in the region received timely assessment by an oncologist if they became acutely unwell as a result of their cancer or its treatment. The AOS consisted of a thrice-weekly ward round, and daily telephone advice service.We report on patient data during the first 12 months of the pilot study. Delivery of the AOS enhanced communication between the services and provided inter-professional education and support, resulting in earlier oncological team involvement in the management of patients with cancer admitted under other teams, as well as provision of advice to patients and their caregivers and families. Provision of the AOS shortened the mean length of hospital stay by 6 days. Two case studies are presented to illustrate the typical challenges faced when managing these patients.Establishment of the AOS enabled effective collaboration between the oncology and other clinical teams to provide a rapid and streamlined referral pathway of patients to the AOS. Locally, this process has been supported by the development of acute oncology protocols, which are now in use across the local cancer network. Journal of Comorbidity 2012;2:10-17.
Immunotherapies and targeted treatments: the future of cancer therapy
Patients diagnosed with thin cutaneous melanoma usually have a good prognosis after surgical resection, but prognosis is poor for those who present with, or develop, metastatic malignant melanoma (stage IV disease). Average survival is less than 12 months, and this has remained unchanged for more than 20 years.1 The mainstay of treatment in advanced melanoma has been dacarbazine chemotherapy, which has a poor response rate of 8-10%.1 However, the past three years have seen important advances in systemic treatment options for patients with this disease. Two treatment strategies, based on immunotherapy and genomics, now offer real hope of improved quality of life and prolonged survival, albeit with a serious risk of side effects and high drug costs.
It is now clear that the immune system has an important influence on the outcome of several cancers not previously thought to be immunogenic.2 Melanoma is an immunogenic tumour in that it expresses melanoma specific antigens, and a clinical response to immunotherapy has been shown. Better understanding of the complex molecular interactions needed to generate an immune response has led to the development of effective new immunotherapy agents.
Cytotoxic T lymphocyte associated antigen 4 (CTLA-4) is a key negative regulatory molecule. It is expressed on the surface of T cells shortly after activation by antigen presenting cells and inhibits the immune response. Ipilimumab is a fully humanised monoclonal antibody that competitively binds CTLA-4, resulting in increased T cell activation and proliferation.
A phase III trial randomised patients with metastatic …
Gestational trophoblastic disease (GTD) is a rare complication of pregnancy, ranging from molar pregnancy to choriocarcinoma. Patients with persistent disease require treatment with chemotherapy. For the vast majority, prognosis is excellent. Occasionally, GTD is complicated by hyperthyroidism, which may require treatment. This is thought to occur due to molecular mimicry between human chorionic gonadotrophin (HCG) and thyroid-stimulating hormone (TSH), and hence cross-reactivity with the TSH receptor. Hyperthyroidism usually resolves as the GTD is successfully treated and correspondingly HCG levels normalise. This paper reviews cases of GTD treated over a 5-year period at one of the three UK centres and identifies the prevalence of hyperthyroidism in this population. Four cases with clinical hyperthyroidism are discussed. On review of the 196 patients with gestational trophoblastic neoplasia treated with chemotherapy in Sheffield since 2005, 14 (7%) had biochemical hyperthyroidism. Of these, four had evidence of clinical hyperthyroidism. Concomitant biochemical thyroid disease in patients with GTD is relatively common, and measurement of thyroid function in patients with persistent GTD is, therefore, important. The development of hyperthyroidism is largely influenced by the level of HCG and disease burden, and usually settles with treatment of the persistent GTD. However, rarely the thyroid stimulation can have potentially life-threatening consequences.
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