International Journal of Cancer Care and DeliveryOrdering chemotherapy within an Electronic medical record (EMR) can be a seamless process while working in a resource-rich setting.Implementing it in a under resourced setting can be challenging.Binaytara Foundation Cancer Center recently started using Karexpert EMR for inpatient and outpatient use.This was a major step in creating a paper-free experience at the hospital.However, Karexpert lacked the functionality to order chemotherapy within the EMR.The administration of chemotherapy is a complex process involving various stages, including drug protocol selection, dosage calculation, and schedule planning.The use of an electronic medical record (EMR) system facilitates the implementation of a chemotherapy order set and improve the safety and efficiency of the treatment process.We are documenting our experience of implementing chemotherapy order sets in Karexpert at Binaytara Foundation Cancer Center.

By Tara Shah, Binay Shah. IJCCD provides oncology professionals a platform for sharing research and experiences with barriers to cancer care delivery & solutions they have identified, tested, and implemented to navigate those barriers.

Background: Medico-legal case usually presents as an emergency case in any hospital. Profiling of these cases provides with evidence on the burden of the medico-legal cases and identifying ways to better manage these cases in the emergency ward of hospitals. Objective: To study the profile of medico-legal cases coming to the emergency ward of B. P. Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal. Material & Methods: We conducted a retrospective review of all medico-legal cases presenting in the emergency ward of BPKIHS from April 2015 to March 2016. The cases were profiled for socio-demography, injury and diagnosis from the medico-legal register at the emergency ward of BPKIHS. Results: Medico-legal cases comprise almost 10% of all cases at the emergency ward of BPKIHS. A total of 3,715 cases were included in this study. Half (50.0%) of the cases fell in to the category of 25-59 years. Males were almost twice (62.7%) in number, compared to females (37.3%). The top three diagnoses among medico-legal cases are road traffic accidents (41.81%), physical assault (21.13%) and poisoning (20.08%). Other diagnoses were burns, fall injury, sexual assault, self inflicted injury, hanging, gunshot injury, stab injury, machinery injury, drug overdose, blast injury, brought dead, trauma by animal, electrical injury, snake bite and human bite. Conclusions: There are significant numbers and wide varieties of medico-legal cases that present in the emergency ward of BPKIHS. Given the large number of cases presenting at BPKIHS, there is a potential for future research on medico-legal cases for academic and policy purpose.

Lenvatinib, an oral multikinase inhibitor, was approved by the US Food and Drug Administration in February 2015. In a pivotal phase III study of 392 patients with progressive radioiodine-refractory thyroid cancer, the overall response rate of patients receiving lenvatinib was 64.8%, with complete response in four patients. The median progression-free survival was 18.3 months in the lenvatinib arm versus 3.6 months in patients receiving placebo. Median overall survival was not reached in either arm. Lenvatinib is a promising new treatment for patients with radioiodine (iodine-131)-refractory differentiated thyroid cancer.

The premarketing surveillance showed that the incidence of olanzapine-induced seizure was 0.88%. However, the data of post-marketing surveillance of olanzapine-induced seizure was limited. The causal effect of olanzapineinduced seizure was not established yet. We report a case of a 48-year old female who had olanzapine-induced convulsive status epilepticus. Olanzapine was used for the treatment of post-capsular ischemic stroke hemichorea. Olanzapine can induce generalized tonic-clonic, focal and myoclonic seizure. An olanzapine-induced seizure is often self-limited with drug withdrawal. However, few patients with olanzapine-induced therapy need anticonvulsant therapy. Olanzapine can induce the seizure especially in patients with multiple medical co-morbidities.

Background/Aim: The majority of cancers affect the elderly, but 22.4% of all cases occur in the ages of 21-55. This age range represents common childbearing and child-rearing years, which imply that many of these patients have minor children. Approximately 2.85 million children under 18 live with a parent affected by cancer. Materials and Methods: The Pubmed and Google Scholar were searched to identify literature on impact of parental cancer on children and potential interventions to support parents and children. Results: We reviewed impact of parental cancer on daily routine, role changes, emotional problems and social functioning of children. We also discuss interventions that may be useful for parents and children. Conclusion: It is essential that we learn more about the impact of parental cancer on children and ways to support the families using evidence-based interventions.

Welcome to Annals of Global Health,Annals of Global Health is a peer-reviewed, fully open access, online journal dedicated to publishing high quality articles dedicated to all aspects of global health. The journal's mission is to advance global health, promote research, and foster the prevention and treatment of disease worldwide. Its goals are to improve the health and well-being of all people, advance health equity, and promote wise stewardship of the earth's environment. The latest journal impact factor is 3.64.Annals of Global Health is supported by the Program for Global Public Health and the Common Good at Boston College. It was founded in 1934 by the Icahn School of Medicine at Mount Sinai as the Mount Sinai Journal of Medicine. It is a partner journal of the Consortium of Universities for Global Health. Authors of articles accepted for publication in Annals of Global Health will be asked to pay an Article Publication Charge (APC) to cover publication costs. This charge can normally be sourced from your funder or institution. We are committed to supporting authors from all countries to publish their work in Annals of Global Health regardless of national income level, and to achieve this goal, we waive the Article Publication Charge for manuscripts where all authors are from low-income or lower-middle-income countries (as defined by the World Bank). From time to time, Annals of Global Health publishes Special Collections, a series of articles organized around a common theme in global health. Recent Special Collections have included “Strengthening Women’s Leadership in Global Health”, “Decolonizing Global Health Education”, and “Capacity Building for Global Health Leadership Training”. Global health workers interested in developing a Special Collection are strongly encouraged to contact the Managing Editor in advance to discuss the project.

e15643 Background: Sorafinib was approved for advanced hepatocellular carcinoma in 2007. This study was conducted to study relative survival in elderly patients with advanced hepatocellular carcinoma in presorafinib and sorafinib era. Methods: We selected elderly patients (age ≥ 65 years) with advanced hepatocellular carcinoma (distant metastasis based on SEER’s LRD staging) from the Surveillance, Epidemiology, and End Results (SEER) database diagnosed during January 2000 to December 2013. We calculated one year and five year relative survival rates in pre- (2000-2006) and post- sorafinib (2008-2013) era by sex and ethnicity (Caucasians, African-Americans (AA) & Other) using SEER*Stat software. Results: There were total of 1533 patients in presorafinib era and 1694 patients in postsorafinib era. Of the total population, 71.30% were male and 28.70% female, 71% were Caucasian, 10% African-American and 19% were other race. Median age of patients was 73 years (65-99 years) and medial follow up period was 3 months (0-167 months) Survival rates improved significantly from pre- to post- sorafenib era (1 year RS: 10.60% ±0.80% vs 12.10±0.90%, p value = 0.001; 5 year RS: 1.10%±0.30% vs 1.8%±0.6%, p value = 0.001 ). The survival rate improved significantly for male (1 year RS: 11.60%±1.00% vs 12.30%±1.00%, p value = 0.006; 5 year RS: 1.00%±0.40% vs 1.3%± 0.6% , p value = 0.007) and Caucasian (1 year RS: 10.60%±1.00% vs 12.60%±1.10%, p value = 0.0008; 5 year RS: RS = 1.20%±0.40% vs 1.4%±0.7%, P value = 0.001) patients in post sorafenib era. There was no significant difference in the survival rates among any other cohorts examined.However in black (N = 153 vs 158 , RS = 6.80%±2.10% vs 7.80%±2.40% , p value = 0.77) or other races (N = 311 vs 311, RS = 12.20%±1.90% vs 12.80%±2.10%, p value = 0.30 ) , no significant improvement in survival was noted. Conclusions: Our study showed that relative survival rates of elderly patients with advanced hepatocellular carcinoma with distant metastasis has improved in the post-sorafenib compared to pre-sorafenib era. The improvement in survival is limited to male and Caucasian patients.

Leptomeningeal metastasis is an uncommon but serious complication in patients with advanced cancers. Leptomeningeal metastasis is diagnosed in approximately 5% of the patients, most commonly among patients with cancers of breast and lung, melanoma, and gastrointestinal malignancies. Treatment goal is to improve survival and quality of the patients. Use of targeted therapies and immunotherapy has led to improved survival of patients with non-small cell lung cancer (NSCLC). In this article, we review emerging data on use of mutation-specific agents and immunotherapy in the treatment of leptomeningeal metastasis among patients with NSCLC.

e18090 Background: There has been significant improvement in survival among patients with primary Chronic Lymphocytic Leukemia (CLL) in recent years but, not much is known about survival among CLL developed after a first primary malignancy. Methods: SEER 18 database, 2015 submission, was used to calculate 5 and 10 year relative survival (RS) by period survival modeling method for 1993 to 2012, with division of the period into 4 cohorts of 5 years each. SEER*Stat software from National Cancer Institute was used to calculate relative survival (RS) for 4 different periods of 5 years duration. The trend in survival for cases with CLL as second primary cancer (CLLSPC) was evaluated using COX proportional hazard method using Cansurv software and also compared with that of primary CLL cases. Results: A total of 8731 patients with CLLSPC were included in the study, which represents 14.5% of all cases of CLL. The median age at diagnosis was 75 years. Median time to diagnosis of CLL was 50 months after diagnosis of first primary malignancy. Prostate cancer, breast cancer and colorectal cancer were 3most common primary cancers. 5-year and 10-year RS improved significantly in the year 2008-2012 compared to 1993-1997 (59.3% to 70.2%,P 0.044 and 40.1% to 50.6%, p 0.045). In subgroup analysis, significant improvement in 5-year and 10-year RS was seen in females and ≥ 80 years age group but no significant improvement was observed in males and age group 60-79 years. Survival among CLLSPC was significant worse compared to first primary CLL in all periods, even after adjusting for age and sex. Conclusions: CLLSPC represents about 14.5% of all CLL cases. Relative survival among patients with CLLSPC is gradually improving but still lags behind that of CLL as first primary cancer.

BackgroundNepal is a low-income country in south Asia with a population of more than 27 million people. Because of late diagnosis and poor access to care, almost 90% of approximately 60 000 people diagnosed with cancer in Nepal annually will die within 1 year of diagnosis. Here, we describe our experience in successfully establishing a home hospice programme in Kathmandu, Nepal.MethodsIn 2015, Binaytara Foundation, a US-based non-profit organisation, collaborated with a Nepal-based non-profit organisation, Cancer Care Nepal, to develop a home hospice programme in Kathmandu. We interviewed 150 terminally ill patients and their family to investigate the need for a hospice programme. A project leader (a Nepali physician) was appointed. In the second phase of the programme, we trained health-care providers and implemented electronic medical records. A hospice nurse practitioner from Idaho, USA, travelled to Nepal to train 15 Nepali nurses. A motorbike was provided for the hospice nurse to travel to patients' homes.FindingsThe hospice programme was launched in January, 2016. By September, 2016, 65 patients had been enrolled in home hospice care. The service is provided free of charge to the patients and their family. The cost of running the hospice programme is US$17 per day. All costs, including equipment, salary, staff training, electronic medical records, fuel, and other monthly expenses have been paid for by Binaytara Foundation.InterpretationHome hospice programmes are very important in low-income countries like Nepal where most patients with cancer are diagnosed at late stages, and many patients do not have access to cancer centres. To make a home hospice project successful, several factors, such as the selection of an appropriate local partner organisation, training, and financial support are necessary and the project should respect local cultural contexts.FundingNone

ISSN: 0284-186X (Print) 1651-226X (Online) Journal homepage: https://www.tandfonline.com/loi/ionc20 Chronic lymphocytic leukemia presenting with hematuria Binay Kumar Shah, Taufiq Rajwani, Samir Jha & Ryan R. Fortna To cite this article: Binay Kumar Shah, Taufiq Rajwani, Samir Jha & Ryan R. Fortna (2017) Chronic lymphocytic leukemia presenting with hematuria, Acta Oncologica, 56:1, 113-115, DOI: 10.1080/0284186X.2016.1256496 To link to this article: https://doi.org/10.1080/0284186X.2016.1256496

BACKGROUND/AIM Concomitant and adjuvant temozolomide along with radiotherapy following surgery (the Stupp regimen) is the preferred therapy for young patients with glioblastoma as well as for elderly (>70 years) ones with favorable risk factors. This study investigated the survival trend since the introduction of the use of the Stupp regimen in elderly patients in a population-based setting. MATERIALS AND METHODS Surveillance, Epidemiology, and End Results 18 database was used to identify patients aged ≥70 years with glioblastoma as the first primary cancer diagnosed from 1999 to 2010. Chi-square test, Kaplan-Meier analysis with log-rank test and Cox proportional hazard method were used for analysis. RESULT A total of 5,575 patients were included in the survival analysis. Survival in Stupp era (year of diagnosis ≥2005) was significantly better compared to the pre-Stupp era with p<0.001 by log-rank test, with 1-, 2- and 3-year overall survival of 18.8% vs. 12.9%, 6.5% vs. 2.1% and 3.1% vs. 0.9% respectively, and hazard ratio for death in 3 years in the Stupp era was 0.87 (95% confidence interval=0.82-0.92; p<0.001) when compared with the pre-Stupp era. Factors such as younger age (<85 years), female sex, married status, Caucasian race and total resection favored better survival compared to their counterparts. CONCLUSION This study shows that the survival of elderly patients with glioblastoma has improved since the introduction of the Stupp regimen. However, there are significant differences in survival rates among various cohorts.

BACKGROUNDCombination chemoradiotherapy is the standard of care for treatment of non-metastatic squamous cell carcinoma of the anus (SCCA). This population based study evaluated disparities in receipt of radiotherapy (RT) as well as comparative survival rates for SCCA patients in the United States.METHODSThe Surveillance, Epidemiology, and End Results (SEER) 18 database was used to identify patients with non-metastatic SCCA diagnosed between 1998 and 2008. Multivariate logistic regression was used to model the relationships between age, sex, and race and the receipt of RT, adjusting for marital status and stage of disease. Relative survival (RS) rates were compared by each factor, with added adjustment for RT status, using Cox proportional hazards model.RESULTSA total of 3,885 patients with localized or regional SCCA as the only primary malignancy were included in the study, of which, 3,192 (82%) received RT. In our multivariate analysis, lower rates of RT were found for those 65+ years old [adjusted odds ratio (OR) 0.71; P<0.001], males (adjusted OR 0.65; P<0.001), and blacks (adjusted OR 0.78; P=0.049). Multivariate survival analysis showed worse survival among those 65+ years old (adjusted HR 1.65; P<0.001), males (adjusted HR 1.53; P<0.001), and blacks (adjusted HR 1.35; P=0.001).CONCLUSIONSThis population based study identified older patients, males, and blacks as less likely to receive RT. Worse survival was also found in these groups.

BACKGROUND/AIM A second primary malignancy is a serious long-term complication in cancer survivors. The aim of this study was to evaluate the risk of second primary malignancies in patients with hepatocellular carcinoma (HCC). MATERIALS AND METHODS We selected adult patients (≥18 years) diagnosed with HCC from the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) 13 database. We calculated the risk of second primary malignancies in these patients using multiple primary standardized incidence ratio (MP-SIR) session of SEER* stat software. Second primary malignancy was defined as a metachronous malignancy diagnosed 6 months or more after an index HCC. RESULTS A total of 15,296 patients with a diagnosis of primary HCC were reported in the SEER 13 registry during January 1992 to December 2011. A total of 446 (2.83%) developed 466 second primary malignancies with an observed/expected ratio of 10.07 (95% confidence interval=0.97-1.17, p=0.16) and absolute risk of 7.17 per 10,000 population. Risk of stomach and of thyroid cancer were significantly increased among older patients. Risk of lung cancer and of hepatobiliary cancer were significantly higher compared to that of the general population after two years of latency. CONCLUSION Risk of specific second primary malignancies in adult patients with HCC depends on age of the patient and latency.

e18511 Background: Use of all trans-retinoic acid (ATRA), Arsenic trioxide and anthracycline based chemotherapy has significantly improved long term survival in acute promyelocytic leukemia(APL). There is limited data on second primary malignancy in APL survivors. This study was conducted to study the second primary malignancies (SPM) in APL in United States. Methods: We included adult acute promyelocytic leukemia patients aged 18 years and older from National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) 13 database in the study. We calculated the risk of second primary malignancies in the APL patients using multiple primary standardized incidence ratio (MP-SIR) session of SEER*stat software. Results: There were total of 1177 patients diagnosed with acute promyelocytic leukemia from January 1992 to December 2011. Their median follow up period was 38 months (0 - 127 months). Median age at the time of diagnosis of SPM was 65 years (20 years - 87 years). Median latency period for development of SPM was 75 months (6 - 178 months). Among APL survivors, forty two patients (3.47%) developed 47 second primary malignancies with O/E ratio of 1.09 and excess risk of 5.52 (p value = 1.15, 95% CI = (0.8-1.46).Overall there was no increased risk of cancer among APL survivors. However, among patients of 18-59 years age group, there was significant increase in salivary gland tumor (N = 3) with O/E ratio of 60.42 and excess risk of 5.51 (p value = < 0.05, 95% CI = 12.46 - 176.58). Among patients aged 60 years and above, urinary bladder carcinoma was the most common second primary malignancy. Five cases (17.85%) were reported during the study period with O/E ratio of 3.36 and excess risk of 22.49 ( p value = 0.03, 95% CI = 1.03 - 7.85). Both salivary gland tumor and urinary bladder cancers had latency of 5 years or more. Conclusions: Risk of salivary gland tumors and urinary bladder cancer is increased among APL survivors after 5 years of latency period compared to the general population.