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Background: The costs of cancer care in the US continue to increase and may have serious consequences for patients. We hypothesize that even cancer patients treated with curative-intent surgery alone experience substantial financial burden. Methods: A questionnaire was administered to adult cancer patients who were treated with curative-intent surgery. Survey items included a validated instrument for measuring financial toxicity, the COST score. Demographic variables and survey responses were examined using Chi-square and Fisher exact tests. A multivariate general linear model was performed to examine the relationship between age and COST score. Results: COST scores varied widely. 30% of respondents had a COST score of ≤24 (high burden). Younger participants reported more financial burden (p = 0.008). Respondents reported that financial factors influenced their decisions regarding surgery (14%) and caused them to skip recommended care (4.7%). Cancer care influenced overall financial health (38%) and contributed to medical debt (26%). Conclusion: Curative-intent cancer care places a substantial portion of patients at risk for financial toxicity even when they don’t require chemotherapy. Interventions should not be limited to patients receiving chemotherapy.

A large body of work in animals and humans supports the hypothesis that metabolic acidosis has a deleterious effect on the progression of kidney disease. Alkali therapy, whether pharmacologically or through dietary intervention, appears to slow CKD progression, but an appropriately powered randomized-controlled trial with a low risk of bias is required to reach a more definitive conclusion. Recent work on urinary ammonium excretion has demonstrated that the development of prognostic tools related to acidosis is not straightforward, and that application of urine markers such as ammonium may require more nuance than would be predicted based on our understanding of the pathophysiology.

All cases of uterine perforation occurring during intracavitary application for carcinoma of the cervix over a 13-year period (1968-1981) were reviewed. There were 14 perforations out of 799 applications in 622 patients, for an incidence of 2.25% of patients and 1.75% of applications. In most cases, it is sufficient to halt the application and carefully monitor the patient, as supported by the uneventful post-perforation course in 12 cases. Nine patients (64%) underwent subsequent intracavitary application without further complications; of these, 8 are still living or died without evidence of tumor. In the other 5, it was impossible to locate the cervical canal on subsequent applications. Alternative treatments, results of therapy, and analysis of failures are presented. The authors conclude that there is no direct evidence that uterine perforation alters the prognosis following radiation therapy for carcinoma of the cervix.

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