జర్నల్ ఆఫ్ ఆంకాలజీ మెడిసిన్ & ప్రాక్టీస్

Objective: We conducted a qualitative assessment of oncologists’ preferences for comorbidity capture methods comparing the ICD-9 claims-based approach to the Adult Comorbidity Evaluation-27 (ACE-27) record abstraction approach. Materials and Methods: Building upon theoretical foundations in anthropology, we developed a qualitative methodology to elicit the thoughts and reactions of 21 practicing oncologists about their preferences for claims-based vs. record-abstraction methods of capturing comorbidity. Grounded theory approach was used to identify recurring themes and dominant concerns expressed by multiple respondents. Codes were developed and applied in two phases: initial and focused. Results: Thematic analysis of qualitative interviews revealed five key domains of concern: accuracy, specificity, utility, robustness and the ease of use of the information for clinical decision-making. There was a strong preference among physician respondents for comorbidity information captured through chart abstraction methods such as the ACE-27. Most respondents felt that claims-based comorbidity data, although easy to capture in the process of billing and coding medical encounters, generally lacked a level of specificity and robustness, thereby rendering the information less clinically useful. Conclusion: For complex, chronic conditions, claims-based comorbidity was seen by respondents as superficial, nonspecific and at times inaccurate in which case medical record abstraction data would be preferred.

Introduction: Cytopenia is one of the most important side effects of chemotherapy. It presents as pancytopenia or bicytopenia or monocytopenia. Cytopenia is a challenging factor for delivering chemotherapy drugs. Methods: In this study we were looking for the incidence of cytopenia in patients received chemotherapy in two different hospitals. Results: 200 patients were included in our study. Most of the patients were female and anemia was the most adverse effect which was followed by leukopenia and thrombocytopenia. Bicytopenia and pancytopenia were the least side effects of chemotherapy drugs. Conclusion: Although our study was not a head to head one anemia was the most adverse effect following systemic chemotherapy in both hospitals. Overall cytopenia was more prevalent in the university hospital than private hospital. This difference was significant for anemia (P-value ≤ 0.05) but it wasn’t for leukopenia or thrombocytopenia. Bicytopenia and pancytopenia happened very rarely.

Background: Management of gastric cancer is based on multidisciplinary approach and guidelines. Emerging countries face different issues in the oncologic pathologies and need a deep acknowledge of their epidemiology and prognostic factors. The aim of this study was to describe the clinical and therapeutic features of gastric cancer in Tunisian patients treated in the gastroenterology's department in "RABTA" academic hospital of Tunis. Methods: We retrospectively analyzed the files of 144 gastric adenocarcinoma diagnosed and treated since 2001-2011. Population was divided into 2 Groups according to whether patients were treated before 2006 (Group I) or after (Group II). Results: We included only 126 cases: 73 patients in Group I vs. 53 in Group II. The median age was 60 years in Group I vs. 57.5 years in Group II. Sex-ratio was 2.84 and 1.3 respectively. Malnutrition was reported in 38% vs. 24% of cases respectively in the Group I and II (p=0.02). Group II had significantly more locally advanced stages such as T4 in 6.8% vs. 18.8% (p=0.04). A total of 46 patients’ vs. 29 had surgical removal: for curative intent in 38% vs. 30% of cases (p=0.34) and for palliative intent in 12.3% vs. 11.3% of cases (p=0.86) respectively in Group I and II. The perioperative treatment was performed in only 2.7% vs. 5.6% of cases (p=0.23); adjuvant chemotherapy in 9.3% vs. 33% (p=0.01) and adjuvant radio-chemotherapy in 9.3% vs. 26.6% (p=0.07). Palliative chemotherapy in metastatic forms was used more frequently after 2006 (52% vs. 92%; p=0.38). After a mean follow-up of 13 months, overall survival at 5 years was 15 vs. 18% respectively in Group 1 and 2 (p=0.9). Conclusion: In our series, the management of these patients has evolved overtime in terms of preoperative staging and adjuvant treatment. There are still efforts to be made to better introduce the perioperative and neo adjuvant therapy in the treatment of Tunisian patients.