Real-world study of the impact of recurrent/metastatic squamous cell carcinoma of the head and neck (R/M SCCHN) on quality of life and productivity in Europe.

BACKGROUND: Although current therapy for patients with early-stage squamous cell carcinoma of the head and neck (SCCHN) is potentially curative, the recurrence rate is high. Patients with recurrent or metastatic (R/M) SCCHN have a poor prognosis and substantial disease burden, including impaired health-related quality of life (HRQoL), productivity loss and indirect costs, such as need for caregiver support. The aim of this study was to characterize the impact of R/M SCCHN and its first-line treatment on patient and caregiver quality of life, daily activities and work productivity using real-world evidence from Europe. METHODS: This was a multicentre retrospective study of patients with R/M SCCHN in France, Germany, Italy, Spain and the United Kingdom incorporating patient and caregiver surveys, and a physician-reported medical chart review, conducted between January and May 2019. Patients aged 18 or over with a physician confirmed diagnosis R/M SCCHN completed four validated measures of disease activity and its impact on quality of life and work productivity, while caregivers also completed questionnaire to assess the burden of providing care. Physicians provided data for clinical characteristics, patient management, testing history and treatment patterns. RESULTS: A total of 195 medical/clinical oncologists provided data for 937, predominantly male (72%) patients, with almost half of patients aged over 65 years. The most frequently reported symptoms were fatigue (43%), weight loss (40%), pain (35%) and difficulty swallowing (32%). The EXTREME regimen was the most common first line therapy in over half of patients, who reported moderate or extreme pain/discomfort, and anxiety/depression, and problems with self-care resulting in a diminished health status compared with the general population. Only 14% were employed with high absenteeism or presenteeism, and over half of patients had a caregiver for whom the burden of care was substantial. CONCLUSION: Our results provide real-world insight into the multi-faceted burden associated with R/M SCCHN. The combination of poor HRQoL and the impairment in daily activities, social life and employment illustrates the wider impact of R/M SCCHN on patients and their caregivers, and highlights a need for novel 1 L treatment regimens to improve the humanistic and productivity burdens of this cancer.

European white paper: oropharyngeal dysphagia in head and neck cancer.

PURPOSE: To develop a European White Paper document on oropharyngeal dysphagia (OD) in head and neck cancer (HNC). There are wide variations in the management of OD associated with HNC across Europe. METHODS: Experts in the management of specific aspects of OD in HNC across Europe were delegated by their professional medical and multidisciplinary societies to contribute to this document. Evidence is based on systematic reviews, consensus-based position statements, and expert opinion. RESULTS: Twenty-four sections on HNC-specific OD topics. CONCLUSION: This European White Paper summarizes current best practice on management of OD in HNC, providing recommendations to support patients and health professionals. The body of literature and its level of evidence on diagnostics and treatment for OD in HNC remain poor. This is in the context of an expected increase in the prevalence of OD due to HNC in the near future. Contributing factors to increased prevalence include aging of our European population (including HNC patients) and an increase in human papillomavirus (HPV) related cancer, despite the introduction of HPV vaccination in various countries. We recommend timely implementation of OD screening in HNC patients while emphasizing the need for robust scientific research on the treatment of OD in HNC. Meanwhile, its management remains a challenge for European professional associations and policymakers.

Inverted duplications on acentric markers: mechanism of formation.

Acentric inverted duplication (inv dup) markers, the largest group of chromosomal abnormalities with neocentromere formation, are found in patients both with idiopathic mental retardation and with cancer. The mechanism of their formation has been investigated by analyzing the breakpoints and the genotypes of 12 inv dup marker cases (three trisomic, six tetrasomic, two polysomic and one X chromosome derived marker) using a combination of fluorescence in situ hybridization, quantitative SNP array and microsatellite analysis. Inv dup markers were found to form either symmetrically with one breakpoint or asymmetrically with two distinct breakpoints. Genotype analyses revealed that all inv dup markers formed from one single chromatid end. This observation is incompatible with the previously suggested model by which the acentric inv dup markers form through inter-chromosomal U-type exchange. On the basis of the identification of DNA sequence motifs with inverted homologies within all observed breakpoint regions, a new general mechanism is proposed for the acentric inv dup marker formation: following a double-strand break an acentric fragment forms, during either meiosis or mitosis. The open DNA end of the acentric fragment is stabilized by the formation of an intra-chromosomal loop promoted by the presence of sequences with inverted homologies. Likely coinciding with the neocentromere formation, this stabilized fragment is duplicated during an early mitotic event, insuring the marker's survival during cell division and its presence in all cells.

Ethnobotanical survey and testing of plants traditionally used against hematophagous insects in Eritrea.

An ethnobotanical study was conducted to find plants traditionally used against nuisance insects in three regions of Eritrea: highland, eastern escarpment and wet lowland. Six plants were collected, two of them were reported to be used against mosquitoes (Ocimum forskolei, Lamiaceae and Nicotiana glauca, Solanaceae), two others against fleas (Salvia shimperi, Lamiaceae and Otostegia integrifolia, Lamiaceae) and Neorautanenia mitis (Fabaceae) and Calpurnea aurea (Fabaceae) against animal lice. The effect of fresh leaves and shoots of O. forskolei hanging on walls at the head and foot of beds was tested in Eritrea against Anopheles arabiensis and 53% reduction in mean number of mosquitoes per house was achieved. Blood meals of mosquitoes collected from houses and pit shelters were analysed to determine whether biting diversion occurred due to the use of plants in the houses. No diversion of biting was observed to goats, which are abundant in the test area. Hot water distillates of N. glauca, S. schimperi and O. integrifolia were tested against An. gambiae s.s. in the laboratory using a Hemotek membrane blood feeder with pig skin replacing the parafilm membrane. The approximate doses in microl/cm(2) for 50% repellency with the extracts of S. schimperi, N. glauca and O. integrifolia were 0.97, 1.72 and 2.44, respectively. Even though the plants only achieved partial protection, they have a potential for widespread use as a complement to other control methods.

Debe regresar el uso del DDT para el control de vectores de la malaria / Should the use of DDT be revived for malaria vector control?

Indoor residual spraying with DDT was the principle method by which malaria transmission was eradicated or greatly reduced in many countries between the late 1940s and 1970s. Since then, decreasing use of DDT has been associated with a resurgence of malaria in India, Sri Lanka, former Soviet Central Asia, Zanzibar, Venezuela and several other Latin American countries. In India and Zanzibar, DDT resistance in vectors, as well as a decline in spray coverage, are probable causes of reduced effectiveness of DDT in recent decades. In southern Europe, eradication of malaria transmission was achieved by DDT spraying in the 1940s and 50s and eradication has been sustained by adequate treatment of imported human malaria cases. In the highlands of Madagascar and South Africa, recent reversion to DDT spraying has been successful in stemming resurgences of malaria. Continued use of DDT for vector control, but not for agriculture, is approved by the Stockholm Convention on Persistent Organic Pollutants. DDE residues in breast milk have been associated with DDT anti-malaria spraying in South Africa, but it is not known whether this is harmful. A claimed association of DDE residues with breast cancer have not been substantiated. There is a recent report of association of DDE residues with probability of premature birth; the possible relevance of this to anti-malarial use of DDT should be investigated. In Colombia, testing of the DDT stockpile for suspensibility, DDT resistance in Anopheles darlingi and investigation of the present affordability of widespread spraying with DDT, compared with alternative chemicals, are recommended.

Should the use of DDT be revived for malaria vector control?

Indoor residual spraying with DDT was the principle method by which malaria transmission was eradicated or greatly reduced in many countries between the late 1940s and 1970s. Since then, decreasing use of DDT has been associated with a resurgence of malaria in India, Sri Lanka, former Soviet Central Asia, Zanzibar, Venezuela and several other Latin American countries. In India and Zanzibar, DDT resistance in vectors, as well as a decline in spray coverage, are probable causes of reduced effectiveness of DDT in recent decades. In southern Europe, eradication of malaria transmission was achieved by DDT spraying in the 1940s and 50s and eradication has been sustained by adequate treatment of imported human malaria cases. In the highlands of Madagascar and South Africa, recent reversion to DDT spraying has been successful in stemming resurgences of malaria. Continued use of DDT for vector control, but not for agriculture, is approved by the Stockholm Convention on Persistent Organic Pollutants. DDE residues in breast milk have been associated with DDT anti-malaria spraying in South Africa, but it is not known whether this is harmful. A claimed association of DDE residues with breast cancer have not been substantiated. There is a recent report of association of DDE residues with probability of premature birth; the possible relevance of this to anti-malarial use of DDT should be investigated. In Colombia, testing of the DDT stockpile for suspensibility, DDT resistance in Anopheles darlingi and investigation of the present affordability of widespread spraying with DDT, compared with alternative chemicals, are recommended.