Immunotherapy, particularly immune checkpoint inhibitors, has significantly impacted cancer treatment by enhancing the immune system's ability to identify and attack cancer cells. However, this treatment introduces unique immune-related adverse events (irAEs), which require careful management due to their potential to affect multiple organ systems. IrAEs can manifest during or after treatment, affecting organs such as the gastrointestinal tract, endocrine glands, lungs, and liver, with symptoms ranging from mild to life threatening. While irAEs are distinct from those seen in traditional cancer treatments, their early recognition and appropriate management are crucial. Steroid therapy and other immunosuppressive treatments are often necessary to mitigate these effects. Guidelines from organizations like ESMO and ASCO recommend a structured approach for evaluating and managing irAEs, including staging the severity, ruling out other diagnoses, and adjusting treatment protocols accordingly. Medical doctors need to stay vigilant, as the indications for immune checkpoint inhibitors continue to expand. The potential for delayed onset of irAEs months after treatment cessation increases the importance of maintaining irAEs on the differential diagnosis list for an extended period, even after patients have stopped immune checkpoint inhibitor therapy.

PurposeUniversal screening for Lynch syndrome (LS) on resected colorectal carcinomas (CRCs) and endometrial carcinomas (ECs) was implemented in Iceland in 2017 using immunohistochemistry (IHC) for mismatch repair (MMR) proteins. We examined the efficacy of the universal screening algorithm to detect LS and the diagnostic accuracy of MMR IHC by comparing results with a population-based genotype database.MethodsAll patients diagnosed with CRC or EC per the Icelandic Cancer Registry from 2017 to 2019 who had tumor MMR IHC performed were included. Pathology reports and patient charts were reviewed. MMR IHC stains were crossmatched with genotyping results obtained from the deCODE database.ResultsIHC staining was done on 404 patients with CRC and 74 patients with EC. A total of 61 (15.1%) patients with CRC and 15 (20.3%) patients with EC were MMR-deficient. MMR IHC had 88.9% sensitivity in identifying patients with LS and a positive predictive value of 10.7%. Only 50% of individuals were appropriately referred for genetic testing, leading to underdiagnosis of LS.ConclusionUniversal screening for LS using MMR protein IHC in CRC and EC accurately identified patients appropriate for genetic testing in a population with MSH6 and PMS2 LS predominance. Because of lack of referral to genetic counseling, only 50% of patients with LS were identified through the screening algorithm.

Vart hefur farið framhjá læknum undanfarna mánuði að illa var staðið að flutningi skimana leghálskrabbameina frá Krabbameinsfélaginu til heilsugæslunnar. Krabbameinsfélagið var brautryðjandi í skimun krabbameina á Íslandi. Ég tel að sú ákvörðun að flytja skimanir til heilsugæslunnar hafi verið rétt því eðlilegt er að sú starfsemi eigi heima innan heilsugæslunnar til framtíðar litið. Á undirbúningsfundum var ítrekað bent á mikilvægi þess að standa vel að þessum flutningi þar sem skipulag í kringum lýðgrundaðar skimanir eins og innköllunarskrár, greiningar og eftirfylgd er umfangsmikið og flókið verkefni. Að fylgjast síðan með hvernig að þessu var staðið var með ólíkindum.

In this article the incidence and mortality for cancer of the colon and rectum in Iceland is discussed. The two most common screening methods, faecal immunochemical test (FIT) and colonoscopy are compared and an estimate of cost and benefits for the Icelandic society will be made. The incidence of cancer of the colon and rectum has been increasing in Iceland in last decades but mortality has decreased and survival improved. However, more individuals die from cancer of the colon and rectum than from both breast- and cervical cancer added together. It is likely that screening for cancer of the colon and rectum, could prevent at least 6 of the 28 deaths related to those cancers, occurring yearly in Iceland in screening age, given a screening ages of 50-74 years. The extra cost for the Icelandic community due to the implementation of screening for cancer of the colon and rectum will be acceptable due to the lower cost of simpler treatments, lower cancer incidence and reduced mortality.

Cardio-oncology is a relatively new, albeit quickly expanding field. The efficacy of modern cancer therapy has increased the number of long-term cancer survivors. However, the long-term survival for cancer patients may in some cases be limited by cardiovascular toxicities secondary to necessary

Background: Physical activity (PA) during and after cancer treatment can help with symptom management and reduce the risk of cancer recurrence. However, it is unclear what constitutes an optimal exercise program. In addition, provider and patient barriers exist to the recommendation and adoption of exercise as part of a cancer treatment plan. The goal of this study was to determine how providers and patients feel about exercise during cancer treatment and explore what the barriers to implementing such a program might be. Patients and Methods: Focus groups and interviews were held with patients with malignancy, both metastatic and nonmetastatic, and oncology providers. In total, 20 patients participated in either a focus group or an individual interview and 9 providers contributed to the focus group. An equal number of patients (n=10) were interviewed as attended a focus group. Audiotaped sessions were transcribed verbatim. Theme identification was independently coded by 4 coders and synthesized as a group. Results: Neither patient group recalled PA instruction from oncology providers during their cancer treatment. Most participants (95%) felt exercise is important during cancer treatment, citing overall well-being benefits versus improved disease outcome. Most patients (80%) preferred a home-based exercise program provided by the oncologist. Fatigue was the most cited barrier to regular exercise during treatment (50%). All providers acknowledged benefits of PA to patients, but not universally for all. More than half of providers (55%) preferred a referral system for exercise programs. Clinic visit time constraints and a perceived lack of expertise in the area of PA were common barriers to making exercise recommendations a routine part of the treatment plan. Conclusions: Patients with cancer and oncologists recognize the benefits of PA during treatment. Disagreement exists between to whom, how, and where exercise plans should be disseminated and implemented.

238 Background: Cancer organizations recommend physical activity as part of therapy to aid in symptom management, reduce recurrence and improve overall quality of life. What the optimal exercise program should look like and what stakeholder barriers exist are unclear. Methods: We convened three focus groups, one with metastatic patients, one with non-metastatic patients, one with the providers in the Cancer Center and conducted individual interviews at Gundersen Health System in La Crosse, Wisconsin. The constant comparative method was used to identify themes about exercise as part of cancer treatment. Results: No statistical differences in demographic characteristics exist between metastatic (N = 9) and non-metastatic (N = 11) patients. Impacts of exercise on cancer, who should instruct patients about exercise and how/where the exercise should take place emerged as the main themes. Discordance between patients and providers (N = 10) was identified in these areas. Patients felt that exercise during treatment provided intrinsic value (“Exercise mentally is important”) whereas providers connect exercise to positive disease outcome (“There are decreased recurrence rates for multiple different malignancies that have been proven in large studies”). Patients resoundingly expressed a desire to receive instructions for exercise from their oncologist (“I rely a lot on my oncologist...they are tuned into you”). Providers expressed a desire for a referral process to a cancer trained physical therapist or trainer who would guide patients through an exercise program (“to have assistance from someone who is trained… would be really beneficial”). Conclusions: Providers recognize the importance of exercise as part of a cancer treatment plan, yet they agree that time constraints associated with a busy practice impacts the priority of exercise instructions. Bridging the gap we identified between patient and providers’ perceptions has potential for cancer care across the nation. We plan to further study the discord after designing standard exercise recommendations at varied levels of intensity through collaboration with oncology providers, physical therapy and Livestrong personnel utilizing venues in our region.

Colorectal cancer is the third most common cancer in the Western hemisphere and the incidence increases with increasing age. Most colorectal cancers are localized with or without lymph node metastases. Up to 20% of patients present with metastatic disease, most commonly to the liver. Surgery is the only curative therapy for localized colorectal cancer and adjuvant chemotherapy is usually recommended for patients with lymph node metastases. Surgery, radiation therapy and chemotherapy are the key components of rectal cancer therapy. Selected patients with recurrent and metastatic disease can be salvaged with surgery but chemotherapy remains the mainstay of therapy for advanced colorectal cancer. Substantial progress has been observed in the treatment of metastatic colorectal cancer in recent years.

Krabbamein í ristli og endaþarmi eru þriðja algengasta tegund krabbameina í hinum vestraena heimi

BACKGROUND:The increasing incidence of cancer combined with prolonged survival times seen throughout the western world increases the need for rehabilitation. Diagnosis and treatment for cancer may have substantial effects on the patients' physical, psychological, social and existential well-being. The aim of this paper is to describe the current situation in cancer rehabilitation in the Nordic countries, the Netherlands and Germany.MATERIAL AND METHODS:Description of the current situation in cancer rehabilitation in the Nordic countries and literature review.RESULTS:Rehabilitation as defined by multiple organizations covers a multidimensional view on chronic disease and its effect on the patient's life. The rehabilitation systems in Denmark, Finland, Sweden, Germany and the Netherlands differ depending on the differing social security and health-care systems, but rehabilitation provided is largely based on a similar, multidimensional and multidisciplinary understanding of cancer rehabilitation. Research on rehabilitation efforts in European countries indicates that there is substantial evidence with regard to single interventions which can be part of cancer rehabilitation.DISCUSSION:In order to assure patients and families continuing quality of life, rehabilitation should be an integral and continuous part of all cancer care.

Variants of hepatitis C virus (HCV) from a single infected blood donor and 13 viraemic recipients who were traced were examined by sequencing and cloning to determine the extent of virus diversity in hypervariable region 1. Serum-derived viral isolates were studied from the donor when his HCV infection was discovered in 1993, in his recipients that year (0.3-5 years post-transfusion) and 5 years later in the donor and six viraemic recipients who were still alive. Viral variants of broad diversity were readily demonstrated in the baseline samples of the donor (nucleotide p-distance 0.130), but significantly less (P<0.00003) diversity was observed in the recipients' first samples (p-distances within recipients 0.003-0.062). In the first blood samples of the recipients, many of the viral variants identified were closely related to a strain variant from the donor. In follow-up samples drawn 5 years later from the donor and six recipients, the p-distance among donor clones had increased (0.172, P<0.0005) compared with the recipients, who displayed significantly narrower quasispecies (0.011-0.086). A common finding was that recipients of blood components processed from the same donation differed substantially in persisting HCV infectious sequence. Markedly few changes leading to changes of amino acids had occurred during follow-up in four of six recipients. These results question the significance of the development of viral variants as a necessary phenomenon in the evolution of HCV and pathogenesis of the disease.

Eight antibody-positive individuals were detected among 12,000 blood donations during the first year of screening blood donors for hepatitis C virus (HCV) antibodies in Iceland. All 8 were found to have a history of intravenous drug abuse. Six of these 8 individuals had previously donated blood to 27 patients who could be traced and examined for HCV infection. The great majority (23/27, 85%) of the recipients had demonstrable HCV antibodies. Furthermore, RNA analysis with the polymerase chain reaction showed that all patients with HCV antibodies had HCV RNA in their serum and in one hemodialysis patient without HCV antibodies viral RNA could be demonstrated. Genotyping of the HCV strains showed that the genotype of the donor was also identified in all but one of the infected recipients of his/her blood or blood products. This study, therefore, substantiates high infectivity of the HCV by blood or blood factor donation and shows that viremic HCV antibody-negative individuals exist.