Cancer Considerations
Breast Cancer in Postmenopausal Women
Paper Presentation in a Themed Session Samuel E. Moskowitz
We shall discuss promising research in breast cancer therapy and diagnostic tests. Gene mutations increase with age. Alterations can transform a benign tumor into a cancerous lesion. Treatment for postmenopausal women is simple mastectomy. Ductal carcinoma in situ is a common form. Cancerous tumors produce markers in blood and urine at high rate. Recently introduced is the experimental biological therapy Adopted Immunotherapy. Tumor cells undergo genetic changes that make their surface antigens less conspicuous to killer T cells. Nevertheless, tumor infiltrating lymphocytes are found within tumors. These cytotoxic cells recognize the modified antigen. They are then sequestered, grown in the laboratory into vast numbers, and infused back into the patient. A checkpoint inhibitor prevents these T cells from attaching to the antigen on normal cells. Hormones estrogen and progesterone receptors help detect breast cancer. There is an affinity for attachment of hormones to a tumor and then act as growth factors. Production and adherence of hormones consequently are curtailed. Expressions of several genes can yield the expectation of recurrence somewhere in the body. High probability suggests ten instead of five year duration of hormone therapy. Another test examines under fluorescent lighting if chromosomes of tumors were damaged by the malignancy. Tumor infiltrating lymphocytes are found within tumors. These cytotoxic cells recognize modified antigens. They are grown in the laboratory into large numbers, and infused back into the patient. One test yields the probability of recurrence and implies duration of hormone therapy. Another determines if any damage to tumor chromosomes occurred.
Analysis of Hospitalization Behavior of Patients With Malignant Tumors in Terminal Stage in Shanghai
Paper Presentation in a Themed Session Duo Chen, Changying Wang
Through analyzing behavior of malignant tumors in terminal stage, characteristics and problems of hospitalization behavior were summarized. Evidence was used to adjust and optimize the allocation of medical resources. Terminal stage means the last two years before death. All insured residents died from malignant tumor in 2016 were included. Data came from Shanghai Health Information Network Database.In 2016, 13.8 million malignant tumors died in medical institutions in Shanghai. The proportion of age 56-85 were 78.36%. The demand for hospitalization increased sharply near death. The average hospital admissions were 5.39 times. Per capita admissions increased from 1.21 in penultimate month to 1.56 in the last month of death. The admissions happened in the last quarter accounted for 44.60%. Patients could choose medical institutions. The hospitalization institutions composition was consistent with the distribution of oncology department beds, which was 56.58% in tertiary hospitals and 35.76% in secondary hospitals. The proportion of patients staying in one hospital accounted for 44.87%. About 90% of patients were referred to less than three institutions. The patients with over 10 referral hospitals accounted for 0.52%. As for referring status, 40.34% patients were referred from tertiary hospitals to lower level institutions. The proportion of referred patients to higher institutions was 21.36%. The referral of patients had obvious regional clustering. Referral happened frequently in institutions within medical groups, or located closely. We conclude that regional medical centers and grass-roots medical institutions should be strengthened to alleviate the pressure of tertiary hospitals and facilitate elderly patients' treatment.
