Predictors of Higher Quality of Systematic Reviews Addressing Nutrition and Cancer Prevention.

Systematic reviews/meta-analyses (SR/MAs) are considered a reliable source of information in healthcare. We aimed to explore the association of several characteristics of SR/MAs addressing nutrition in cancer prevention and their quality/risk of bias (using assessments from AMSTAR-2 and ROBIS tools). The analysis included 101 SR/MAs identified in a systematic survey. Associations of each specified characteristic (e.g., information about the protocol, publication year, reported use of GRADE, or other methods for assessing overall certainty of evidence) with the number of AMSTAR-2 not met ('No' responses) and the number of ROBIS items met ('Probably Yes' or "Yes' responses) were examined. Poisson regression was used to identify predictors of the number of 'No' answers (indicating lower quality) for all AMSTAR-2 items and the number of 'Yes' or 'Probably Yes' answers (indicating higher quality/lower concern for bias) for all ROBIS items. Logistic regression was used to identify variables associated with at least one domain assessed as 'low concern for bias' in the ROBIS tool. In multivariable analysis, SR/MAs not reporting use of any quality/risk of bias assessment instrument for primary studies were associated with a higher number of 'No' answers for all AMSTAR-2 items (incidence rate ratio (IRR) 1.26, 95% confidence interval (CI) 1.09-1.45), and a lower number of 'Yes' or 'Probably Yes' answers for all ROBIS items (IRR 0.76, 95% CI 0.66-0.87). Providing information about the protocol and search for unpublished studies was associated with a lower number of 'No' answers (IRR 0.73, 95% CI 0.56-0.97 and IRR 0.75, 95% CI 0.59-0.95, respectively) and a higher number of 'Yes' or 'Probably Yes' answers (IRR 1.43, 95% CI 1.17-1.74 and IRR 1.28, 95% CI 1.07-1.52, respectively). Not using at least one quality/risk of bias assessment tool for primary studies within an SR/MA was associated with lower odds that a study would be assessed as 'low concern for bias' in at least one ROBIS domain (odds ratio 0.061, 95% CI 0.007-0.527). Adherence to methodological standards in the development of SR/MAs was associated with a higher overall quality of SR/MAs addressing nutrition for cancer prevention.

Development and Validation of the Polish Version of Questionnaire for the Assessment of Psychosocial and Functional Effects of Metastatic Breast Cancer.

The aim of this study is to adapt culturally and validate a questionnaire assessing experiences of metastatic breast cancer (MBC) patients in Poland. The questionnaire development was divided into three phases: bidirectional translation of the survey, testing it for acceptability and relevance, and field testing. In the field study, 320 women with MBC completed the questionnaire, 50 of them twice for retest. Basic psychometric properties of the items used in questionnaire were analyzed. Test-retest reliability was assessed using kappa coefficient. In case of some items, known-group validity was verified. We made minor revisions to the construction and wording of the questionnaire. The analysis of the variables distributions used in the final version of the questionnaire showed that there were no redundant response categories across items. We checked for the floor and ceiling effect. It was found that there were a total of < 40% respondents selecting the lowest or the highest possible score. The observed values of the Kappa coefficients indicated high tool's stability. We compared predefined groups for known-group validity; few expected associations reached statistical significance, which supported the overall validity of the tool. The questionnaire has been successfully developed. The results confirm the validity, reliability, and applicability.

Are systematic reviews addressing nutrition for cancer prevention trustworthy? A systematic survey of quality and risk of bias.

CONTEXT: The last 30 years have yielded a vast number of systematic reviews and/or meta-analyses addressing the link between nutrition and cancer risk. OBJECTIVE: The aim of this survey was to assess overall quality and potential for risk of bias in systematic reviews and meta-analyses (SRMAs) that examined the role of nutrition in cancer prevention. DATA SOURCES: MEDLINE, Embase, and the Cochrane Library databases were searched (last search performed November 2018). STUDY SELECTION: Studies identified as SRMAs that investigated a nutritional or dietary intervention or exposure for cancer prevention in the general population or in people at risk of cancer and in which primary studies had a comparison group were eligible for inclusion. Screening, data extraction, and quality assessment were conducted independently by 2 reviewers. DATA EXTRACTION: Altogether, 101 studies were randomly selected for analysis. The methodological quality and risk of bias were evaluated using the AMSTAR-2 and ROBIS tools, respectively. RESULTS: Most SRMAs included observational studies. Less than 10% of SRMAs reported a study protocol, and only 51% of SRMAs assessed the risk of bias in primary studies. Most studies conducted subgroup analyses, but only a few reported tests of interaction or specified subgroups of interest a priori. Overall, according to AMSTAR-2, only 1% of SRMAs were of high quality, while 97% were of critically low quality. Only 3% had a low risk of bias, according to ROBIS. CONCLUSIONS: This systematic survey revealed substantial limitations with respect to quality and risk of bias of SRMAs. SRMAs examining nutrition and cancer prevention cannot be considered trustworthy, and results should be interpreted with caution. Peer reviewers as well as users of SRMAs should be advised to use the AMSTAR-2 and/or ROBIS instruments to help to determine the overall quality and risk of bias of SRMAs. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration number CRD42019121116.

Similarities, reliability and gaps in assessing the quality of conduct of systematic reviews using AMSTAR-2 and ROBIS: systematic survey of nutrition reviews.

BACKGROUND: AMSTAR-2 ('A Measurement Tool to Assess Systematic Reviews, version 2') and ROBIS ('Risk of Bias in Systematic Reviews') are independent instruments used to assess the quality of conduct of systematic reviews/meta-analyses (SR/MAs). The degree of overlap in methodological constructs together with the reliability and any methodological gaps have not been systematically assessed and summarized in the field of nutrition. METHODS: We performed a systematic survey of MEDLINE, EMBASE, and the Cochrane Library for SR/MAs published between January 2010 and November 2018 that examined the effects of any nutritional intervention/exposure for cancer prevention. We followed a systematic review approach including two independent reviewers at each step of the process. For AMSTAR-2 (16 items) and ROBIS (21 items), we assessed the similarities, the inter-rater reliability (IRR) and any methodological limitations of the instruments. Our protocol for the survey was registered in PROSPERO (CRD42019121116). RESULTS: We found 4 similar domain constructs based on 11 comparisons from a total of 12 AMSTAR-2 and 14 ROBIS items. Ten comparisons were considered fully overlapping. Based on Gwet's agreement coefficients, six comparisons provided almost perfect (> 0.8), three substantial (> 0.6), and one a moderate level of agreement (> 0.4). While there is considerable overlap in constructs, AMSTAR-2 uniquely addresses explaining the selection of study designs for inclusion, reporting on excluded studies with justification, sources of funding of primary studies, and reviewers' conflict of interest. By contrast, ROBIS uniquely addresses appropriateness and restrictions within eligibility criteria, reducing risk of error in risk of bias (RoB) assessments, completeness of data extracted for analyses, the inclusion of all necessary studies for analyses, and adherence to predefined analysis plan. CONCLUSIONS: Among the questions on AMSTAR-2 and ROBIS, 70.3% (26/37 items) address the same or similar methodological constructs. While the IRR of these constructs was moderate to perfect, there are unique methodological constructs that each instrument independently addresses. Notably, both instruments do not address the reporting of absolute estimates of effect or the overall certainty of the evidence, items that are crucial for users' wishing to interpret the importance of SR/MA results.

Assessment of Psychosocial and Functional Effects of Metastatic Breast Cancer in Tarnow Region of Poland and Among the Social Media Polish Group-Results from the Survey from Patients.

The aim of the study was a comprehensive assessment of metastatic breast cancer patients' needs in Poland. We conducted and culturally adapted and validated "Count Us, Know Us, Join Us" Metastatic Breast Cancer Survey between November 2018 and July 2019. Two hundred ten patients treated in Tarnów completed the paper questionnaires distributed conveniently by healthcare professionals, and 110 patients completed the online survey. Almost all patients believe that new therapies are necessary, and over a half find their options of treatment limited. Support from family, friends, and healthcare professionals seems sufficient. Most patients declare a negative impact of the disease on their emotional status and ability to maintain their lifestyle, finances, and job with one-third of respondents being employed. Three-quarters of patients actively seek data about cancer. The main source of information for Polish patients is the Internet, and they are primarily interested in the ways of managing side effects and available treatment options. We identified factors related to satisfaction with communication with the healthcare professionals. The results are generally consistent with similar studies across the universe. This may indicate that several issues have not been addressed over the years, and there is an urgent need to join international forces to raise awareness and support for metastatic breast cancer patients and lobby for better treatment outcomes.

Support for Metastatic Breast Cancer Patients-a Systematic Review.

Our study objective was to evaluate existing evidence on different types of support received by metastatic breast cancer patients as well as the need for support expressed by such patients. We searched Medline and EMBASE up to January 2019 for survey studies that aimed to assess any type of support among women of any age, with metastatic breast cancer diagnosis. Two reviewers independently screened titles and abstracts, then full texts of retrieved records against inclusion/exclusion criteria, and extracted the data and assessed the quality of included studies with AXIS tool. From a total of 2876 abstracts, we selected 100 potentially eligible full-text articles, and finally, we included 12 records reporting on 11 studies. Due to the variability of methods used to measure and define support, it was not possible to quantitatively synthesize data; therefore, we synthesized them narratively. The quality of the included studies was moderate. We found that most patients are satisfied with the received psychosocial, emotional, informational, and medical support. In the analysis of any support received from a certain type of group of people, we found that the majority of patients reported receiving sufficient support from their family, friends, and healthcare providers. Ten studies showed a high need for informational support. If asked about the need for psychosocial, medical, and sexual support, women also declared the need for such support. Our review revealed that the patients generally receive support from their community but they express high need for information and treatment choice. PROSPERO CRD42019127496.

A retrospective analysis on safety and effectiveness of hypofractioned post-mastectomy radiotherapy.

The data supporting hypofractionated post-mastectomy radiotherapy is limited. The purpose of this study is to present the experience from Tarnów of hypofractionated PMRT over 20 fractions with respect to toxicity and effectiveness. We delivered post-mastectomy radiotherapy at the dose of 45 Gy in 20 fractions to the chest wall and the draining regional lymph nodes. The primary outcome of interest was to ensure that the rate of grade 3 or greater toxicity from the hypofractionation, at any time point, was non-inferior to standard post-mastectomy radiotherapy. We conducted a retrospective analysis of 211 women with stages I-IV breast cancer. After a median follow-up of 30 months, there were four reported grade 3 toxicities, with grade 3 lymphedema being the most frequent (1.5%). There were 134 reported grade 2 toxicities, with grade 2 fatigue being the most frequent (18%). There were six instances of isolated locoregional (6 of 211; 2.8%). Three-year estimated local recurrence-free survival was 96.4% (95% CI 0.921-0.984). The 3-year estimated distant recurrence-free survival was 77.8% (95% CI 0.699-0.838). To our knowledge, the results presented here are the largest single institution experience of hypofractionated post-mastectomy radiotherapy published in the literature to date. Our fractionation scheme, 45 Gy in 20 fractions, seems to be safe and effective with low toxicity.

How to become a breast cancer specialist in 2018: The point of view of the second cohort of the Certificate of Competence in Breast Cancer (CCB2).

Breast cancer (BC) is the most frequent cancer in women and the leading cause of cancer death in females worldwide. Rapid research advancements add to the complexity of treatment options for this disease. It is known that the quality of patients' care is deeply affected by healthcare professionals following these advancements. There is a growing need for academic education to increase clinical knowledge and skills of physicians treating BC patients. The certificate of Competence in Breast Cancer Program (CCB) is a Certificate in Advanced Studies (CAS) organized by the European School of Oncology in cooperation with Ulm University (Germany), which focuses on both the clinical and scientific competence required for improving quality in the management of BC patients. This paper describes the experience of the second CCB cohort (CCB2), which brought together 24 physicians from four continents who shared the common will to improve their competence and skills in BC treatment.

Assessment of frequency and severity of hypomagnesemia in patients with metastatic colorectal cancer treated with cetuximab, with a review of the literature.

Currently, there are a few systemic treatment options for patients with metastatic colorectal cancer (mCRC). Targeted therapy used in this setting includes the use of monoclonal antibodies, such as cetuximab or panitumumab, directed against epidermal growth factor receptor. The aim of the present study was to estimate the frequency and severity of hypomagnesemia among patients with mCRC treated with cetuximab. The data from the Department of Clinical Oncology, University Hospital of Krakow (Krakow, Poland), concerning 52 patients treated between 2009 and 2013 were collected. Of these, 27 patients fulfilled the inclusion criteria to enter this retrospective study. The National Cancer Institute Common Terminology Criteria for Adverse Events version 4.0 were used to grade the level of hypomagnesemia. In total, 29.6% of all patients experienced hypomagnesemia during treatment, and the majority of cases were grade 1 (22.2%). There was no statistically significant correlation between magnesium (Mg) level and patient age, duration of treatment, localization of primary tumor or metastases, and the number of metastases. However, there was an upward trend in a logistic regression model showing that the risk of developing hypomagnesemia increases with age. Hypomagnesemia is a frequent problem among mCRC patients receiving cetuximab. It is essential to introduce guidelines regarding the monitoring of the Mg level and its supplementation in this group of patients.

Astrocytoma malignum in glioblastoma multiforme vertens with long term survival--case report and a literature review.

Glioblastoma multiforme is the most common and most lethal pri- mary malignant tumor of the central nervous system. It can develop as a primary tumor or by transformation from its precursor--anaplastic astrocytoma which occurs less frequently but the prognosis is also unfavorable. Authors report a case of a 36-year-old man with "astrocytoma malignum in glioblastoma multiforme vertens" in the left frontal lobe. The mass, around 5 cm in diameter was resected by craniotomy 8 years ago. The patient received adiuvant radiation therapy concomitanly with temozolomide. He still stays asymptomatic, with no focal neurologic defects. There is no recurrence in the magnetic resonance imaging.

Oncological emergencies: superior vena cava syndrome.

Superior vena cava obstruction leads to the venous hypertension of the head, neck, upper extremities and upper part of the truncus. Its clinical manifestation, known as the superior vena cava syndrome, is a complication of malignancy, mainly of lung cancer and lymphoma. As it usually affects patients with advanced disease, the prognosis is poor. This article stresses the importance of early detection and adequate management of this onco- logical emergency. The diagnostic tools as well as treatment possibilities are discussed.