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Research and Reviews for the Practicing Oncologist
The generalist’s dilemma: training and staying current in the face of increasing specialization
Click on the PDF icon at the top of this introduction to read the full article.
Click on the PDF icon at the top of this introduction to read the full article.
Click on the PDF icon at the top of this introduction to read the full article.
David Henry's JCSO podcast, April 2015
In this month’s podcast for The Journal of Community and Supportive Oncology, Dr David Henry highlights two Original Reports, one on the effectiveness and safety of ipilimumab therapy in advanced melanoma, and another on the feasibility of implementing a community-based randomized trial of yoga for women who are undergoing chemotherapy for breast cancer. Also in the line-up are a Review article on sleep disorders in patients with cancer; a Community Translations examination of palonosetron and netupitant for the prevention of chemotherapy-induced nausea and vomiting in cancer patients; and Case Reports on distant skin metastases as primary presentation of gastric cancer, and sarcoidosis, complete heart block, and warm autoimmune hemolytic anemia in a young woman. The bimonthly New Therapies feature focuses on hard-to-treat tumors, specifically, glioblastoma, bone sarcoma, and liver cancer.
In this month’s podcast for The Journal of Community and Supportive Oncology, Dr David Henry highlights two Original Reports, one on the effectiveness and safety of ipilimumab therapy in advanced melanoma, and another on the feasibility of implementing a community-based randomized trial of yoga for women who are undergoing chemotherapy for breast cancer. Also in the line-up are a Review article on sleep disorders in patients with cancer; a Community Translations examination of palonosetron and netupitant for the prevention of chemotherapy-induced nausea and vomiting in cancer patients; and Case Reports on distant skin metastases as primary presentation of gastric cancer, and sarcoidosis, complete heart block, and warm autoimmune hemolytic anemia in a young woman. The bimonthly New Therapies feature focuses on hard-to-treat tumors, specifically, glioblastoma, bone sarcoma, and liver cancer.
In this month’s podcast for The Journal of Community and Supportive Oncology, Dr David Henry highlights two Original Reports, one on the effectiveness and safety of ipilimumab therapy in advanced melanoma, and another on the feasibility of implementing a community-based randomized trial of yoga for women who are undergoing chemotherapy for breast cancer. Also in the line-up are a Review article on sleep disorders in patients with cancer; a Community Translations examination of palonosetron and netupitant for the prevention of chemotherapy-induced nausea and vomiting in cancer patients; and Case Reports on distant skin metastases as primary presentation of gastric cancer, and sarcoidosis, complete heart block, and warm autoimmune hemolytic anemia in a young woman. The bimonthly New Therapies feature focuses on hard-to-treat tumors, specifically, glioblastoma, bone sarcoma, and liver cancer.
Glioblastoma, bone sarcoma, and liver cancer: tough battles rage on for some tumors
osteosarcoma, chondrosarcoma, CS, Ewing sarcoma, ES, hepatocellular carcinoma, HCC
osteosarcoma, chondrosarcoma, CS, Ewing sarcoma, ES, hepatocellular carcinoma, HCC
osteosarcoma, chondrosarcoma, CS, Ewing sarcoma, ES, hepatocellular carcinoma, HCC
Sarcoidosis, complete heart block, and warm autoimmune hemolytic anemia in a young woman
Sarcoidosis is a multisystem granulomatous disease that affects 10-40 people per 100,000 in the United States and Europe, with an increased prevalence among blacks compared with whites.1 The clinical presentation of sarcoidosis is variable. Sarcoidosis frequently involves the lungs and can have numerous extrapulmonary manifestations including skin, joint, cardiac, and eye lesions. We present a rare case of sarcoidosis with concurrent third-degree heart block and warm autoimmune hemolytic anemia and discuss possible mechanisms behind this presentation.
Click on the PDF icon at the top of this introduction to read the full article.
Sarcoidosis is a multisystem granulomatous disease that affects 10-40 people per 100,000 in the United States and Europe, with an increased prevalence among blacks compared with whites.1 The clinical presentation of sarcoidosis is variable. Sarcoidosis frequently involves the lungs and can have numerous extrapulmonary manifestations including skin, joint, cardiac, and eye lesions. We present a rare case of sarcoidosis with concurrent third-degree heart block and warm autoimmune hemolytic anemia and discuss possible mechanisms behind this presentation.
Click on the PDF icon at the top of this introduction to read the full article.
Sarcoidosis is a multisystem granulomatous disease that affects 10-40 people per 100,000 in the United States and Europe, with an increased prevalence among blacks compared with whites.1 The clinical presentation of sarcoidosis is variable. Sarcoidosis frequently involves the lungs and can have numerous extrapulmonary manifestations including skin, joint, cardiac, and eye lesions. We present a rare case of sarcoidosis with concurrent third-degree heart block and warm autoimmune hemolytic anemia and discuss possible mechanisms behind this presentation.
Click on the PDF icon at the top of this introduction to read the full article.
Distant skin metastases as primary presentation of gastric cancer
Distant gastric metastasis to the skin is uncommonly a presenting symptom, although nonspecific paraneoplastic syndromes with dermatologic manifestation including diffuse seborrheic keratoses (Leser-Trelat sign), tripe palms, and acanthosis nigricans have been described in the literature. We report here the case of a 49-year-old woman with gastric adenocarcinoma who presented with cutaneous metastasis as an initial symptom. In our case, metastatic skin lesions responded significantly to EOX chemotherapy (epirubicin+oxaliplatin+capecitabine) despite progression of systemic disease. In similar presentations, a high index of clinical suspicion and skin biopsy are important.
Click on the PDF icon at the top of this introduction to read the full article.
Distant gastric metastasis to the skin is uncommonly a presenting symptom, although nonspecific paraneoplastic syndromes with dermatologic manifestation including diffuse seborrheic keratoses (Leser-Trelat sign), tripe palms, and acanthosis nigricans have been described in the literature. We report here the case of a 49-year-old woman with gastric adenocarcinoma who presented with cutaneous metastasis as an initial symptom. In our case, metastatic skin lesions responded significantly to EOX chemotherapy (epirubicin+oxaliplatin+capecitabine) despite progression of systemic disease. In similar presentations, a high index of clinical suspicion and skin biopsy are important.
Click on the PDF icon at the top of this introduction to read the full article.
Distant gastric metastasis to the skin is uncommonly a presenting symptom, although nonspecific paraneoplastic syndromes with dermatologic manifestation including diffuse seborrheic keratoses (Leser-Trelat sign), tripe palms, and acanthosis nigricans have been described in the literature. We report here the case of a 49-year-old woman with gastric adenocarcinoma who presented with cutaneous metastasis as an initial symptom. In our case, metastatic skin lesions responded significantly to EOX chemotherapy (epirubicin+oxaliplatin+capecitabine) despite progression of systemic disease. In similar presentations, a high index of clinical suspicion and skin biopsy are important.
Click on the PDF icon at the top of this introduction to read the full article.
Feasibility of implementing a community-based randomized trial of yoga for women undergoing chemotherapy for breast cancer
Background Treatment-related symptoms and decreased health-related quality of life (HRQoL) frequently occur during chemotherapy for breast cancer. Although research findings suggest that yoga can reduce symptoms and improve HRQoL after treatment, potential benefits of yoga during chemotherapy have received minimal attention.
Objective To estimate accrual, adherence, study retention, and preliminary efficacy of a yoga intervention compared with an active control group for breast cancer patients during chemotherapy.
Methods Women with stage I-III breast cancer were recruited from 3 community cancer clinics and randomized to 10 weeks of gentle yoga or wellness education. Depressive symptoms, fatigue, sleep, and HRQoL were assessed at baseline, mid-intervention (Week 5), and after intervention (Week 10).
Results 40 women aged 29-83 years (median, 48 years; 88% white) were randomized to yoga (n = 22) or wellness education (n = 18). The groups did not differ significantly on baseline characteristics, adherence, or study retention. Participant feedback was positive and comparable between groups. Meaningful within-group differences were identified for sleep adequacy and quantity in yoga participants and for somnolence in wellness-education participants.
Limitations Small sample size and lack of a usual-care control group.
Conclusions This study established feasibility of a community-based randomized trial of yoga and an active comparison group for women undergoing chemotherapy for breast cancer. Preliminary efficacy estimates suggest that yoga improves sleep adequacy. Symptom severity and interference remained stable during chemotherapy for the yoga group and showed a trend toward increasing in the control group. The study highlighted obstacles to multisite yoga research during cancer treatment.
Funding/sponsorship National Cancer Institute (3U10 CA081851, PI: Shaw; R25 CA122061, PI: Avis); Translational Science Institute, Wake Forest School of Medicine
Click on the PDF icon at the top of this introduction to read the full article.
Background Treatment-related symptoms and decreased health-related quality of life (HRQoL) frequently occur during chemotherapy for breast cancer. Although research findings suggest that yoga can reduce symptoms and improve HRQoL after treatment, potential benefits of yoga during chemotherapy have received minimal attention.
Objective To estimate accrual, adherence, study retention, and preliminary efficacy of a yoga intervention compared with an active control group for breast cancer patients during chemotherapy.
Methods Women with stage I-III breast cancer were recruited from 3 community cancer clinics and randomized to 10 weeks of gentle yoga or wellness education. Depressive symptoms, fatigue, sleep, and HRQoL were assessed at baseline, mid-intervention (Week 5), and after intervention (Week 10).
Results 40 women aged 29-83 years (median, 48 years; 88% white) were randomized to yoga (n = 22) or wellness education (n = 18). The groups did not differ significantly on baseline characteristics, adherence, or study retention. Participant feedback was positive and comparable between groups. Meaningful within-group differences were identified for sleep adequacy and quantity in yoga participants and for somnolence in wellness-education participants.
Limitations Small sample size and lack of a usual-care control group.
Conclusions This study established feasibility of a community-based randomized trial of yoga and an active comparison group for women undergoing chemotherapy for breast cancer. Preliminary efficacy estimates suggest that yoga improves sleep adequacy. Symptom severity and interference remained stable during chemotherapy for the yoga group and showed a trend toward increasing in the control group. The study highlighted obstacles to multisite yoga research during cancer treatment.
Funding/sponsorship National Cancer Institute (3U10 CA081851, PI: Shaw; R25 CA122061, PI: Avis); Translational Science Institute, Wake Forest School of Medicine
Click on the PDF icon at the top of this introduction to read the full article.
Background Treatment-related symptoms and decreased health-related quality of life (HRQoL) frequently occur during chemotherapy for breast cancer. Although research findings suggest that yoga can reduce symptoms and improve HRQoL after treatment, potential benefits of yoga during chemotherapy have received minimal attention.
Objective To estimate accrual, adherence, study retention, and preliminary efficacy of a yoga intervention compared with an active control group for breast cancer patients during chemotherapy.
Methods Women with stage I-III breast cancer were recruited from 3 community cancer clinics and randomized to 10 weeks of gentle yoga or wellness education. Depressive symptoms, fatigue, sleep, and HRQoL were assessed at baseline, mid-intervention (Week 5), and after intervention (Week 10).
Results 40 women aged 29-83 years (median, 48 years; 88% white) were randomized to yoga (n = 22) or wellness education (n = 18). The groups did not differ significantly on baseline characteristics, adherence, or study retention. Participant feedback was positive and comparable between groups. Meaningful within-group differences were identified for sleep adequacy and quantity in yoga participants and for somnolence in wellness-education participants.
Limitations Small sample size and lack of a usual-care control group.
Conclusions This study established feasibility of a community-based randomized trial of yoga and an active comparison group for women undergoing chemotherapy for breast cancer. Preliminary efficacy estimates suggest that yoga improves sleep adequacy. Symptom severity and interference remained stable during chemotherapy for the yoga group and showed a trend toward increasing in the control group. The study highlighted obstacles to multisite yoga research during cancer treatment.
Funding/sponsorship National Cancer Institute (3U10 CA081851, PI: Shaw; R25 CA122061, PI: Avis); Translational Science Institute, Wake Forest School of Medicine
Click on the PDF icon at the top of this introduction to read the full article.
Effectiveness and safety of ipilimumab therapy in advanced melanoma: evidence from clinical practice sites in the US
Palonosetron and netupitant for prevention of chemotherapy-induced nausea and vomiting
The US Food and Drug Administration (FDA) recently approved NEPA, an oral fixed-dose combination of netupitant and palonosetron for treatment of chemotherapy-induced nausea and vomiting (CINV). Palonosetron is a pharmacologically distinct, best-in-class serotonin (5-hydroxytryptamine) type 3 (5-HT3) receptor antagonist, which prevents CINV during the acute phase (0-24 h) after administration of chemotherapy, and netupitant is a potent and selective neurokinin-1 (NK-1) receptor antagonist, which prevents CINV during both the acute and delayed (25-120 h) phases. The 2 agents have also been shown potentially to act synergistically in inhibiting NK-1 receptor activity.
Click on the PDF icon at the top of this introduction to read the full article.
The US Food and Drug Administration (FDA) recently approved NEPA, an oral fixed-dose combination of netupitant and palonosetron for treatment of chemotherapy-induced nausea and vomiting (CINV). Palonosetron is a pharmacologically distinct, best-in-class serotonin (5-hydroxytryptamine) type 3 (5-HT3) receptor antagonist, which prevents CINV during the acute phase (0-24 h) after administration of chemotherapy, and netupitant is a potent and selective neurokinin-1 (NK-1) receptor antagonist, which prevents CINV during both the acute and delayed (25-120 h) phases. The 2 agents have also been shown potentially to act synergistically in inhibiting NK-1 receptor activity.
Click on the PDF icon at the top of this introduction to read the full article.
The US Food and Drug Administration (FDA) recently approved NEPA, an oral fixed-dose combination of netupitant and palonosetron for treatment of chemotherapy-induced nausea and vomiting (CINV). Palonosetron is a pharmacologically distinct, best-in-class serotonin (5-hydroxytryptamine) type 3 (5-HT3) receptor antagonist, which prevents CINV during the acute phase (0-24 h) after administration of chemotherapy, and netupitant is a potent and selective neurokinin-1 (NK-1) receptor antagonist, which prevents CINV during both the acute and delayed (25-120 h) phases. The 2 agents have also been shown potentially to act synergistically in inhibiting NK-1 receptor activity.
Click on the PDF icon at the top of this introduction to read the full article.
Managing change in oncology
Sleep disorders in patients with cancer
Sleep disturbances are common among patients with cancer for many reasons. Sleep problems can be present at any stage during treatment for cancer and in some patients, sleep disturbance may be the presenting symptoms that lead to the diagnosis of some types of cancer. Poor sleep impairs quality of life In people with cancer, but most do not specifically complain of sleep problems unless they are explicitly asked. Insomnia and fatigue are most common sleep disorders in this cohort, although primary sleep disorders, including obstructive sleep apnea and restless legs syndrome, which are common in the general population, have not been carefully studied in the oncology setting despite significant their impairment of quality of life.
Click on the PDF icon at the top of this introduction to read the full article.
disorder
Sleep disturbances are common among patients with cancer for many reasons. Sleep problems can be present at any stage during treatment for cancer and in some patients, sleep disturbance may be the presenting symptoms that lead to the diagnosis of some types of cancer. Poor sleep impairs quality of life In people with cancer, but most do not specifically complain of sleep problems unless they are explicitly asked. Insomnia and fatigue are most common sleep disorders in this cohort, although primary sleep disorders, including obstructive sleep apnea and restless legs syndrome, which are common in the general population, have not been carefully studied in the oncology setting despite significant their impairment of quality of life.
Click on the PDF icon at the top of this introduction to read the full article.
Sleep disturbances are common among patients with cancer for many reasons. Sleep problems can be present at any stage during treatment for cancer and in some patients, sleep disturbance may be the presenting symptoms that lead to the diagnosis of some types of cancer. Poor sleep impairs quality of life In people with cancer, but most do not specifically complain of sleep problems unless they are explicitly asked. Insomnia and fatigue are most common sleep disorders in this cohort, although primary sleep disorders, including obstructive sleep apnea and restless legs syndrome, which are common in the general population, have not been carefully studied in the oncology setting despite significant their impairment of quality of life.
Click on the PDF icon at the top of this introduction to read the full article.
disorder
disorder