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Pamala A. Pawloski, Gabriela Vazquez-Benitez, Jeanette Y. Ziegenfuss, Terese A. DeFor and Elisabeth M. Seburg

Background: Older patients diagnosed with colorectal cancer are not routinely included in clinical trials and are frequently treated with less aggressive chemotherapy. To identify factors associated with treatment initiation in older adults, we conducted an observational study of patients diagnosed with stage I–IV colon or rectal cancer at 65 years and older between 2010 and 2014 across 6 integrated health care systems. Methods: Data were obtained from cancer registries based on chart abstraction and medical records. Time from diagnosis to surgery, chemotherapy, and radiation was measured in weeks and censored when disenrollment, death, or the end of the study period occurred. We assessed patient factors associated with time to chemotherapy initiation using survival analysis methods. Results: Among 8,088 patients diagnosed after the age of 65 with colon cancer, the mean age at diagnosis was 76 years (SD 7.7), 4,150 (51%) were female, and 34% were stage 3 or greater. More than half, 55% (n=4,434) of colon cancers were right-sided (RCC), 23% (n=1833) were left-sided (LCC), and 19% (n=1,559) were rectal cancers. Two-thirds (n=5,201) had moderately differentiated disease. Most (57%) received surgery within 4 weeks and 89% within 6 months of diagnosis (median, 3.4 weeks). At 6 months following diagnosis, 33% of patients had received chemotherapy, and only 4% received radiation. Factors associated with the receipt of chemotherapy were assessed in a multivariable survival model that included age, gender, stage, and site. Patients of older age were less likely to receive chemotherapy (HR, 0.49; 95%CI, 0.45–.53 for 75–79 vs 65–69 years), and more likely for advanced stage, and rectal site. No difference was observed between men and women. Refusal of chemotherapy was reported for only 6% of patients and was associated with age, stage, and site. Six month mortality was 13.3%. Conclusions: Factors associated with the receipt of treatment among older cancer survivors are similar to those in the general population.

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Tarek Safi, Pascale Salameh, Lea Aoude, Mirna Waked, FCCP and Bassim Kobrossy

Background: Differences between left and right breast cancer have been investigated in the past in terms of incidence; it is higher on the left side than on the right. This difference has ranged from 2% to 5%. However, there are no publications looking at differences in immunohistochemical characteristics between left and right sided breast cancer. This study aims to assess the incidence and age distribution as well as the following immunohistochemical characteristics: estrogen receptor (ER), progesterone receptor (PR), and epidermal growth factor 2 (HER-2). We compared the age distribution to U.S. population as well as other Arab populations. In addition we compared these and other characteristics with respect to the laterality of the breast cancer. Methods: In this pilot retrospective descriptive study, data was collected anonymously on 300 patients who presented to the Saint George Hospital University Medical Center in Beirut. They were extracted from the inpatient files with a diagnosis of breast cancer in order of presentation from 2012 until the total number of files was reached. The measured parameters included the sex of the patient, the age at diagnosis, breast cancer laterality and stage, the need for surgical treatment, and ER status, PR status, and HER-2 status as shown on the official biopsy results of the cases studied. Results: HER-2, PR-, and ER-positive receptors were found to be more frequent by 4%, 9%, and 1% on the left side as compared with the right side, respectively. These numerical differences, however, were not statistically significant. Moreover, our data analysis shows that the Lebanese population distribution of breast cancer is skewed towards a younger age when compared to the U.S., with a median age of diagnosis of 53 and 62, respectively. Finally, in term of incidence, there was a 12% increase in incidence of left side breast cancer over the right side but this value did not reach statistical significance. Conclusions: This is the first study to show the relationship between hormonal receptors and laterality of breast cancer. We concluded that there is a trend towards statistically significant differences between laterality immunohistochemical characteristics. Epidemiological relationships between the Lebanese population, the Arab population, and the U.S. population were discussed. Further researches on larger population may be needed to show some of the trends presented in this article to be statistically significant.

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Abdul-Rahman Jazieh, Hanaa Bamefleh, Ahmet Demirkazik, Rabab Mohamed Gaafar, Fady B. Geara, Mansur Javaid, Jamal Khader, Kian Khodadad, Walid Omar, Ahmed Saadeddin, Hassan Al Sabe, Mohammad Behgam Shadmehr, Amgad El Sherif, Najam Uddin, Mohammad Jahanzeb and David Ettinger

A lung cancer committee from the Middle East and North Africa (MENA) region was established to modify the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) on Non–Small Cell Lung Cancer to create a platform for standard care in the region. The committee comprised different experts in thoracic oncology from the region, including the disciplines of medical and clinical oncology, radiation oncology, thoracic surgery, pulmonary medicine, radiology, and pathology. The committee reviewed version 2 of the 2009 NCCN Guidelines on Non–Small Cell Lung Cancer and identified recommendations requiring modification for the region using published evidence and relevant experience. These suggested modifications were discussed among the group and with a United States–based NCCN expert for approval. The recommended modifications, with justification and references, were categorized based on the NCCN Guidelines flow. This article describes these recommended modifications. The process of adapting the first NCCN-based guidelines in the region is a step toward helping to improve lung cancer care in the region and encouraging networking and collaboration.

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David S. Ettinger, Debra K. Armstrong, Sally Barbour, Michael J. Berger, Philip J. Bierman, Bob Bradbury, Georgianna Ellis, Steve Kirkegaard, Dwight D. Kloth, Mark G. Kris, Dean Lim, Michael Anne Markiewicz, Lida Nabati, Carli Nesheiwat, Hope S. Rugo, Steven M. Sorscher, Lisa Stucky-Marshal, Barbara Todaro and Susan Urba

Antiemesis Clinical Practice Guidelines in Oncology NCCN Categories of Evidence and Consensus Category 1: The recommendation is based on high-level evidence (e.g., randomized controlled trials) and there is uniform NCCN consensus. Category 2A: The recommendation is based on lowerlevel evidence and there is uniform NCCN consensus. Category 2B: The recommendation is based on lowerlevel evidence and there is nonuniform NCCN consensus (but no major disagreement). Category 3: The recommendation is based on any level of evidence but reflects major disagreement. All recommendations are category 2A unless otherwise noted. Clinical trials: The NCCN believes that the best management for any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged. Overview Chemotherapy-induced vomiting (emesis) and nausea can significantly affect a patient's quality of life, leading to poor compliance with further chemotherapy treatment. Nausea and vomiting can also result in metabolic imbalances, degeneration of self-care and functional ability, nutrient depletion, anorexia, decline of performance and mental status, wound dehiscence, esophageal tears, and withdrawal from potentially useful or curative anticancer treatment.1–4 The incidence and severity of nausea and/or vomiting in patients undergoing chemotherapy are affected by numerous factors, including 1) the specific chemotherapeutic agents used, 2) dosage of the agents, 3) schedule and route of administration of the agents, and 4) individual patient variability (e.g., age, sex, prior chemotherapy, history of alcohol use). Approximately 70% to 80% of all patients undergoing chemotherapy experience nausea and/or vomiting,5,6 whereas 10% to 44% experience anticipatory nausea and/or vomiting;7–10 patients often experience more...
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Douglas E. Wood, George A. Eapen, David S. Ettinger, Lifang Hou, David Jackman, Ella Kazerooni, Donald Klippenstein, Rudy P. Lackner, Lorriana Leard, Ann N. C. Leung, Pierre P. Massion, Bryan F. Meyers, Reginald F. Munden, Gregory A. Otterson, Kimberly Peairs, Sudhakar Pipavath, Christie Pratt-Pozo, Chakravarthy Reddy, Mary E. Reid, Arnold J. Rotter, Matthew B. Schabath, Lecia V. Sequist, Betty C. Tong, William D. Travis, Michael Unger and Stephen C. Yang

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David S. Ettinger, Debra K. Armstrong, Sally Barbour, Michael J. Berger, Philip J. Bierman, Bob Bradbury, Georgianna Ellis, Steve Kirkegaard, Dwight D. Kloth, Mark G. Kris, Dean Lim, Laura Boehnke Michaud, Lida Nabati, Kim Noonan, Hope S. Rugo, Darby Siler, Steven M. Sorscher, Sundae Stelts, Lisa Stucky-Marshall, Barbara Todaro and Susan G. Urba