The Journal of Community and Supportive Oncology

Background Chemotherapy-induced peripheral neuropathy (CIPN) is a major dose-limiting toxicity of cytostatics. With improved survival among cancer patients, CIPN may have a major impact on quality of life (QoL) of cancer survivors.

Objective To determine the occurrence of CIPN induced by oxaliplatin and taxanes and its impact on QoL median 6 months after chemotherapy.

Methods All patients who received their last treatment with oxaliplatin or taxanes in 2 consecutive years in the Máxima Medical Centre, the Netherlands, were eligible for the study. Neurotoxicity and its effect on QoL was assessed with the recently developed Chemotherapy Induced Neurotoxicity Questionnaire (CINQ) and the Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity (FACT/GOG-Ntx) median 6 months after cessation of therapy.

Results Of the 58 eligible patients, 43 (74.1%) completed the questionnaire. After a median follow-up of 6.5 months after cessation of therapy, most of the patients experienced neurotoxicity in the upper and lower extremities (78.8% and 89.7%, respectively). Overall, the most-reported complaints included numbness and tingling in hands as well as feet, suffering from cold feet, and trouble distinguishing objects in the hands. Housekeeping difficulties were reported in 12.8% of patients, and 20.5% of patients became more dependent on others because of the neurotoxicity. Overall, QoL was negatively affected by the impact of CIPN in 48.6% of patients.

Limitations Due to the small sample size selection bias cannot be ruled out and no data about CIPN during treatment were available. Conclusions After a median follow-up of 6.5 months after cessation of therapy with oxaliplatin or taxanes, CIPN is common and leads to impairment in patient QoL. More research is needed to assess the impact of neurotoxicity on QoL.

Click on the PDF icon at the top of this introduction to read the full article.

Background Chemotherapy-induced peripheral neuropathy (CIPN) is a major dose-limiting toxicity of cytostatics. With improved survival among cancer patients, CIPN may have a major impact on quality of life (QoL) of cancer survivors.

Objective To determine the occurrence of CIPN induced by oxaliplatin and taxanes and its impact on QoL median 6 months after chemotherapy.

Methods All patients who received their last treatment with oxaliplatin or taxanes in 2 consecutive years in the Máxima Medical Centre, the Netherlands, were eligible for the study. Neurotoxicity and its effect on QoL was assessed with the recently developed Chemotherapy Induced Neurotoxicity Questionnaire (CINQ) and the Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity (FACT/GOG-Ntx) median 6 months after cessation of therapy.

Results Of the 58 eligible patients, 43 (74.1%) completed the questionnaire. After a median follow-up of 6.5 months after cessation of therapy, most of the patients experienced neurotoxicity in the upper and lower extremities (78.8% and 89.7%, respectively). Overall, the most-reported complaints included numbness and tingling in hands as well as feet, suffering from cold feet, and trouble distinguishing objects in the hands. Housekeeping difficulties were reported in 12.8% of patients, and 20.5% of patients became more dependent on others because of the neurotoxicity. Overall, QoL was negatively affected by the impact of CIPN in 48.6% of patients.

Limitations Due to the small sample size selection bias cannot be ruled out and no data about CIPN during treatment were available. Conclusions After a median follow-up of 6.5 months after cessation of therapy with oxaliplatin or taxanes, CIPN is common and leads to impairment in patient QoL. More research is needed to assess the impact of neurotoxicity on QoL.

Click on the PDF icon at the top of this introduction to read the full article.

Background Chemotherapy-induced peripheral neuropathy (CIPN) is a major dose-limiting toxicity of cytostatics. With improved survival among cancer patients, CIPN may have a major impact on quality of life (QoL) of cancer survivors.

Objective To determine the occurrence of CIPN induced by oxaliplatin and taxanes and its impact on QoL median 6 months after chemotherapy.

Methods All patients who received their last treatment with oxaliplatin or taxanes in 2 consecutive years in the Máxima Medical Centre, the Netherlands, were eligible for the study. Neurotoxicity and its effect on QoL was assessed with the recently developed Chemotherapy Induced Neurotoxicity Questionnaire (CINQ) and the Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity (FACT/GOG-Ntx) median 6 months after cessation of therapy.

Results Of the 58 eligible patients, 43 (74.1%) completed the questionnaire. After a median follow-up of 6.5 months after cessation of therapy, most of the patients experienced neurotoxicity in the upper and lower extremities (78.8% and 89.7%, respectively). Overall, the most-reported complaints included numbness and tingling in hands as well as feet, suffering from cold feet, and trouble distinguishing objects in the hands. Housekeeping difficulties were reported in 12.8% of patients, and 20.5% of patients became more dependent on others because of the neurotoxicity. Overall, QoL was negatively affected by the impact of CIPN in 48.6% of patients.

Limitations Due to the small sample size selection bias cannot be ruled out and no data about CIPN during treatment were available. Conclusions After a median follow-up of 6.5 months after cessation of therapy with oxaliplatin or taxanes, CIPN is common and leads to impairment in patient QoL. More research is needed to assess the impact of neurotoxicity on QoL.

Click on the PDF icon at the top of this introduction to read the full article.

Objective To evaluate the impact of aprepitant on emesis control, DI, and RFS.

Methods HNC patients treated at the British Columbia Cancer Agency were analyzed. Kaplan-Meier method and adjusted Cox proportional hazard models were used to evaluate RFS in aprepitant users. To control for selection bias, a propensity score analysis was conducted.

Results A total of 192 HNC patients were included: 141 received aprepitant prophylaxis. The aprepitant-treated and untreated groups were comparable in mean age (56.3 vs 58.1 years), male gender (82.3% vs 86.3%), tumor location, and number of metastatic sites. However, more patients in the aprepitant group than in the untreated group had surgically resectable disease (31.2% vs 15.7%, respectively) and better performance status (ECOG 0/1, 87.9% vs 76.4%). Less emesis was reported in the aprepitant group (21.3% vs 28.0%). Patients in the treated group were also more likely to complete 3 cycles of high-dose cisplatin (OR, 2.3; P = .03). The propensity score adjusted Cox regression analysis suggested a reduced risk of disease recurrence in patients who received aprepitant (HR, 0.47; 95% CI, 0.17- 1.28).

Limitations Potential confounders such as other diseases or treatments that may have influenced the presence of nausea/emesis symptoms.

Conclusion Aprepitant contributed to improved emesis control, enhanced DI, and better adherence to cisplatin chemotherapy.

Funding/sponsorship The British Columbia Cancer Foundation and Canadian Cancer Society Research Institute. 

Objective To evaluate the impact of aprepitant on emesis control, DI, and RFS.

Methods HNC patients treated at the British Columbia Cancer Agency were analyzed. Kaplan-Meier method and adjusted Cox proportional hazard models were used to evaluate RFS in aprepitant users. To control for selection bias, a propensity score analysis was conducted.

Results A total of 192 HNC patients were included: 141 received aprepitant prophylaxis. The aprepitant-treated and untreated groups were comparable in mean age (56.3 vs 58.1 years), male gender (82.3% vs 86.3%), tumor location, and number of metastatic sites. However, more patients in the aprepitant group than in the untreated group had surgically resectable disease (31.2% vs 15.7%, respectively) and better performance status (ECOG 0/1, 87.9% vs 76.4%). Less emesis was reported in the aprepitant group (21.3% vs 28.0%). Patients in the treated group were also more likely to complete 3 cycles of high-dose cisplatin (OR, 2.3; P = .03). The propensity score adjusted Cox regression analysis suggested a reduced risk of disease recurrence in patients who received aprepitant (HR, 0.47; 95% CI, 0.17- 1.28).

Limitations Potential confounders such as other diseases or treatments that may have influenced the presence of nausea/emesis symptoms.

Conclusion Aprepitant contributed to improved emesis control, enhanced DI, and better adherence to cisplatin chemotherapy.

Funding/sponsorship The British Columbia Cancer Foundation and Canadian Cancer Society Research Institute. 

Objective To evaluate the impact of aprepitant on emesis control, DI, and RFS.

Methods HNC patients treated at the British Columbia Cancer Agency were analyzed. Kaplan-Meier method and adjusted Cox proportional hazard models were used to evaluate RFS in aprepitant users. To control for selection bias, a propensity score analysis was conducted.

Results A total of 192 HNC patients were included: 141 received aprepitant prophylaxis. The aprepitant-treated and untreated groups were comparable in mean age (56.3 vs 58.1 years), male gender (82.3% vs 86.3%), tumor location, and number of metastatic sites. However, more patients in the aprepitant group than in the untreated group had surgically resectable disease (31.2% vs 15.7%, respectively) and better performance status (ECOG 0/1, 87.9% vs 76.4%). Less emesis was reported in the aprepitant group (21.3% vs 28.0%). Patients in the treated group were also more likely to complete 3 cycles of high-dose cisplatin (OR, 2.3; P = .03). The propensity score adjusted Cox regression analysis suggested a reduced risk of disease recurrence in patients who received aprepitant (HR, 0.47; 95% CI, 0.17- 1.28).

Limitations Potential confounders such as other diseases or treatments that may have influenced the presence of nausea/emesis symptoms.

Conclusion Aprepitant contributed to improved emesis control, enhanced DI, and better adherence to cisplatin chemotherapy.

Funding/sponsorship The British Columbia Cancer Foundation and Canadian Cancer Society Research Institute. 

Background Acute promyelocytic leukemia (APL) is a highly curable malignancy. However, 30% of patients die during therapy induction from bleeding, differentiation syndrome (DS), and/or infection. Recommendations suggest that congestive heart failure (CHF) is a presenting feature of DS.

Objective To assess the incidence of CHF during induction in patients with APL.

Methods A retrospective chart review was performed of patients diagnosed with APL from December 2004 to July 2013 and managed at Georgia Regents University Cancer Center. Baseline and follow-up ejection fractions (EF) were recorded and patients with a drop in EF during the induction period were evaluated.

Results Of the 40 evaluable patients, 37 received idarubicin-based chemotherapy. 16 of the 37 patients had a repeat ECHO for suspected cardiomyopathy, and 6 of the 16 patients (37.5%) demonstrated a decrease in EF (absolute drop, 10%-35%). The cardiac function recovered completely in 4 patients and partially in 1 patient. Gender, history of hypertension, and body mass index did not seem to correlate with incidence of CHF.

Limitations The patient population is very small given the rarity of the disease. Present practice patterns do not routinely address CHF in the differential diagnosis.

Conclusions Patients with APL are at risk for cardiac toxicity for a number of reasons, including cytokine storm and inflammatory state, use of anthracyclines, and DS. The clinical presentation of DS most commonly involves dyspnea and fluid retention, which are also symptoms of heart failure. Prompt cardiac evaluation should be undertaken to rule out CHF in APL patients who are going to receive an anthracycline-based therapy, because early intervention may result in an improved outcome.
 

Click on the PDF icon at the top of this introduction to read the full article.

Background Acute promyelocytic leukemia (APL) is a highly curable malignancy. However, 30% of patients die during therapy induction from bleeding, differentiation syndrome (DS), and/or infection. Recommendations suggest that congestive heart failure (CHF) is a presenting feature of DS.

Objective To assess the incidence of CHF during induction in patients with APL.

Methods A retrospective chart review was performed of patients diagnosed with APL from December 2004 to July 2013 and managed at Georgia Regents University Cancer Center. Baseline and follow-up ejection fractions (EF) were recorded and patients with a drop in EF during the induction period were evaluated.

Results Of the 40 evaluable patients, 37 received idarubicin-based chemotherapy. 16 of the 37 patients had a repeat ECHO for suspected cardiomyopathy, and 6 of the 16 patients (37.5%) demonstrated a decrease in EF (absolute drop, 10%-35%). The cardiac function recovered completely in 4 patients and partially in 1 patient. Gender, history of hypertension, and body mass index did not seem to correlate with incidence of CHF.

Limitations The patient population is very small given the rarity of the disease. Present practice patterns do not routinely address CHF in the differential diagnosis.

Conclusions Patients with APL are at risk for cardiac toxicity for a number of reasons, including cytokine storm and inflammatory state, use of anthracyclines, and DS. The clinical presentation of DS most commonly involves dyspnea and fluid retention, which are also symptoms of heart failure. Prompt cardiac evaluation should be undertaken to rule out CHF in APL patients who are going to receive an anthracycline-based therapy, because early intervention may result in an improved outcome.
 

Click on the PDF icon at the top of this introduction to read the full article.

Background Acute promyelocytic leukemia (APL) is a highly curable malignancy. However, 30% of patients die during therapy induction from bleeding, differentiation syndrome (DS), and/or infection. Recommendations suggest that congestive heart failure (CHF) is a presenting feature of DS.

Objective To assess the incidence of CHF during induction in patients with APL.

Methods A retrospective chart review was performed of patients diagnosed with APL from December 2004 to July 2013 and managed at Georgia Regents University Cancer Center. Baseline and follow-up ejection fractions (EF) were recorded and patients with a drop in EF during the induction period were evaluated.

Results Of the 40 evaluable patients, 37 received idarubicin-based chemotherapy. 16 of the 37 patients had a repeat ECHO for suspected cardiomyopathy, and 6 of the 16 patients (37.5%) demonstrated a decrease in EF (absolute drop, 10%-35%). The cardiac function recovered completely in 4 patients and partially in 1 patient. Gender, history of hypertension, and body mass index did not seem to correlate with incidence of CHF.

Limitations The patient population is very small given the rarity of the disease. Present practice patterns do not routinely address CHF in the differential diagnosis.

Conclusions Patients with APL are at risk for cardiac toxicity for a number of reasons, including cytokine storm and inflammatory state, use of anthracyclines, and DS. The clinical presentation of DS most commonly involves dyspnea and fluid retention, which are also symptoms of heart failure. Prompt cardiac evaluation should be undertaken to rule out CHF in APL patients who are going to receive an anthracycline-based therapy, because early intervention may result in an improved outcome.
 

Click on the PDF icon at the top of this introduction to read the full article.

Objective To address gaps in previous research by prospectively examining concordance between HCPs and patients on identifying patients’ symptoms by using an identical tool for patients and HCPs at the time of the oncology clinic visit.

Methods 94 patients completed measures of symptom experience and medical comorbidities before seeing their oncology medical team. HCPs were informed of a patient’s participation in the study before seeing the patient in clinic. Immediately after the clinic visit, HCPs completed a symptom survey in which they noted the patient’s symptoms.

Results Patients reported more symptoms than the HCPs endorsed. The highest level of concordance for any symptom fell in the moderate agreement range. Kappa values reflecting concordance between patients and HCPs were not significantly different between the various patient-HCP pairs. No demographic or clinical variables for patients were found to be statistically related to the level of agreement on patients’ symptoms.

Limitations The use of a small convenience sample size drawn from 3 specialty oncology outpatient clinics may limit the generalizability of the results to other types of cancer. The distribution of cancer stage was weighted toward stages III and IV, likely contributing to the number of symptoms.

Conclusions The level of agreement between HCPs and oncology patients on patient symptoms is weak. Concordance levels were similar, regardless of the type of HCP.

Funding Siteman Cancer Center Summer Student Program. 

Objective To address gaps in previous research by prospectively examining concordance between HCPs and patients on identifying patients’ symptoms by using an identical tool for patients and HCPs at the time of the oncology clinic visit.

Methods 94 patients completed measures of symptom experience and medical comorbidities before seeing their oncology medical team. HCPs were informed of a patient’s participation in the study before seeing the patient in clinic. Immediately after the clinic visit, HCPs completed a symptom survey in which they noted the patient’s symptoms.

Results Patients reported more symptoms than the HCPs endorsed. The highest level of concordance for any symptom fell in the moderate agreement range. Kappa values reflecting concordance between patients and HCPs were not significantly different between the various patient-HCP pairs. No demographic or clinical variables for patients were found to be statistically related to the level of agreement on patients’ symptoms.

Limitations The use of a small convenience sample size drawn from 3 specialty oncology outpatient clinics may limit the generalizability of the results to other types of cancer. The distribution of cancer stage was weighted toward stages III and IV, likely contributing to the number of symptoms.

Conclusions The level of agreement between HCPs and oncology patients on patient symptoms is weak. Concordance levels were similar, regardless of the type of HCP.

Funding Siteman Cancer Center Summer Student Program. 

Objective To address gaps in previous research by prospectively examining concordance between HCPs and patients on identifying patients’ symptoms by using an identical tool for patients and HCPs at the time of the oncology clinic visit.

Methods 94 patients completed measures of symptom experience and medical comorbidities before seeing their oncology medical team. HCPs were informed of a patient’s participation in the study before seeing the patient in clinic. Immediately after the clinic visit, HCPs completed a symptom survey in which they noted the patient’s symptoms.

Results Patients reported more symptoms than the HCPs endorsed. The highest level of concordance for any symptom fell in the moderate agreement range. Kappa values reflecting concordance between patients and HCPs were not significantly different between the various patient-HCP pairs. No demographic or clinical variables for patients were found to be statistically related to the level of agreement on patients’ symptoms.

Limitations The use of a small convenience sample size drawn from 3 specialty oncology outpatient clinics may limit the generalizability of the results to other types of cancer. The distribution of cancer stage was weighted toward stages III and IV, likely contributing to the number of symptoms.

Conclusions The level of agreement between HCPs and oncology patients on patient symptoms is weak. Concordance levels were similar, regardless of the type of HCP.

Funding Siteman Cancer Center Summer Student Program. 

Background Morbidity related to cancer and its treatment remains a significant source of human suffering and a challenge to the delivery of high-quality care.

Objective To develop and apply quality indicators to evaluate quality of supportive care for advanced lung cancer in the Veterans Health Administration (VHA) and examine facility-level predictors of quality.

Methods We evaluated supportive care quality using 12 quality indicators. Data were taken from VHA electronic health records for incident lung cancer cases occurring during 2007. Organizational characteristics of 111 VHA facilities were examined for association with receipt of care.

Results Rates of care-receipt were high, especially in the treatment toxicity (89%) and pain management (79%-98%) domains, but were lower in the palliative cancer treatment (60%-90%) and hospice (75%) domains, with substantial facility- level variation. Presence of a care tracking method that was monitored by a midlevel practitioner seemed to be associated with better quality for treatment toxicity (OR, 3.38; 95% CI, 1.87-6.10) and referral to hospice (OR, 1.60; 95% CI, 1.22-2.28); having a psychologist for cancer patients was associated with higher odds for pain management (OR, 1.76; 95% CI, 1.16-2.66).

Limitations Not all supportive care was evaluated. Care processes identified as present at facilities may not have been applied to cohort patients. Facility-level results may be influenced by errors in attributing a patient’s care to the correct facility.

Conclusions Quality indicators for supportive cancer care can be developed and applied in large evaluations using electronic health record review. This study confirmed high-quality supportive care, while identifying significant facility-level variation in VHA.

Funding Veterans Health Administration Office of Informatics and Analytics.

Click on the PDF icon at the top of this introduction to read the full article.

Background Morbidity related to cancer and its treatment remains a significant source of human suffering and a challenge to the delivery of high-quality care.

Objective To develop and apply quality indicators to evaluate quality of supportive care for advanced lung cancer in the Veterans Health Administration (VHA) and examine facility-level predictors of quality.

Methods We evaluated supportive care quality using 12 quality indicators. Data were taken from VHA electronic health records for incident lung cancer cases occurring during 2007. Organizational characteristics of 111 VHA facilities were examined for association with receipt of care.

Results Rates of care-receipt were high, especially in the treatment toxicity (89%) and pain management (79%-98%) domains, but were lower in the palliative cancer treatment (60%-90%) and hospice (75%) domains, with substantial facility- level variation. Presence of a care tracking method that was monitored by a midlevel practitioner seemed to be associated with better quality for treatment toxicity (OR, 3.38; 95% CI, 1.87-6.10) and referral to hospice (OR, 1.60; 95% CI, 1.22-2.28); having a psychologist for cancer patients was associated with higher odds for pain management (OR, 1.76; 95% CI, 1.16-2.66).

Limitations Not all supportive care was evaluated. Care processes identified as present at facilities may not have been applied to cohort patients. Facility-level results may be influenced by errors in attributing a patient’s care to the correct facility.

Conclusions Quality indicators for supportive cancer care can be developed and applied in large evaluations using electronic health record review. This study confirmed high-quality supportive care, while identifying significant facility-level variation in VHA.

Funding Veterans Health Administration Office of Informatics and Analytics.

Click on the PDF icon at the top of this introduction to read the full article.

Background Morbidity related to cancer and its treatment remains a significant source of human suffering and a challenge to the delivery of high-quality care.

Objective To develop and apply quality indicators to evaluate quality of supportive care for advanced lung cancer in the Veterans Health Administration (VHA) and examine facility-level predictors of quality.

Methods We evaluated supportive care quality using 12 quality indicators. Data were taken from VHA electronic health records for incident lung cancer cases occurring during 2007. Organizational characteristics of 111 VHA facilities were examined for association with receipt of care.

Results Rates of care-receipt were high, especially in the treatment toxicity (89%) and pain management (79%-98%) domains, but were lower in the palliative cancer treatment (60%-90%) and hospice (75%) domains, with substantial facility- level variation. Presence of a care tracking method that was monitored by a midlevel practitioner seemed to be associated with better quality for treatment toxicity (OR, 3.38; 95% CI, 1.87-6.10) and referral to hospice (OR, 1.60; 95% CI, 1.22-2.28); having a psychologist for cancer patients was associated with higher odds for pain management (OR, 1.76; 95% CI, 1.16-2.66).

Limitations Not all supportive care was evaluated. Care processes identified as present at facilities may not have been applied to cohort patients. Facility-level results may be influenced by errors in attributing a patient’s care to the correct facility.

Conclusions Quality indicators for supportive cancer care can be developed and applied in large evaluations using electronic health record review. This study confirmed high-quality supportive care, while identifying significant facility-level variation in VHA.

Funding Veterans Health Administration Office of Informatics and Analytics.

Click on the PDF icon at the top of this introduction to read the full article.

Breast cancer during pregnancy is a therapeutic challenge. Evidence to guide management in metastatic breast cancer during pregnancy is limited, mainly because of a lack of randomized trials. Care needs to be individualized with interdisciplinary collaboration. We present the case of a young woman with HER2/neu overexpressed inflammatory breast cancer who became pregnant while on treatment, refused termination of pregnancy, and developed brain metastasis during the second trimester of pregnancy, posing a management dilemma.

Click on the PDF icon at the top of this introduction to read the full article.

Breast cancer during pregnancy is a therapeutic challenge. Evidence to guide management in metastatic breast cancer during pregnancy is limited, mainly because of a lack of randomized trials. Care needs to be individualized with interdisciplinary collaboration. We present the case of a young woman with HER2/neu overexpressed inflammatory breast cancer who became pregnant while on treatment, refused termination of pregnancy, and developed brain metastasis during the second trimester of pregnancy, posing a management dilemma.

Click on the PDF icon at the top of this introduction to read the full article.

Breast cancer during pregnancy is a therapeutic challenge. Evidence to guide management in metastatic breast cancer during pregnancy is limited, mainly because of a lack of randomized trials. Care needs to be individualized with interdisciplinary collaboration. We present the case of a young woman with HER2/neu overexpressed inflammatory breast cancer who became pregnant while on treatment, refused termination of pregnancy, and developed brain metastasis during the second trimester of pregnancy, posing a management dilemma.

Click on the PDF icon at the top of this introduction to read the full article.