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Research and Reviews for the Practicing Oncologist
Informational needs and the quality of life of patients in their first year after metastatic breast cancer diagnosis
Objective To describe the informational needs and QOL of patients with MBC within the first year of diagnosis, and to identify sociodemographic and medical factors that may be associated with informational needs and QOL.
Methods 52 patients (50 women, 2 men) enrolled within a year of diagnosis of MBC completed a cross-sectional, self-administered paper survey that included patient demographics, the Toronto Informational Needs Questionnaire-Breast Cancer (TINQ), the Hospital Anxiety and Depression Scale (HADS), and Medical Outcomes Study Short Form-36 (SF-36). High informational need was defined as a TINQ score of ≥ 200.
Results Of the total 52 patients, 69% (35/52) had high informational needs, 20% met the criteria for anxiety (HADS-Anxiety score, ≥ 11), and 8% met the criteria for depression. SF-36 scores were lower in all 8 subscales compared with the general population. Multivariate analyses showed that patients who were married or living as married (OR, 6.1; 95% CI, 1.4-28.9) and patients with de novo MBC (OR, 2.8; 95% CI, 0.5-14.3) or a shorter disease-free interval (DFI; < 5 years; OR, 24.2; 95% CI, 3.1-187.4) were more likely to have more informational needs (C statistic, 0.824) than were patients with a longer DFI (≥ 5 years).
Limitations This is a small cross-sectional study of a single academic institution.
Conclusion Patients with recently diagnosed MBC have high informational needs and decreased overall QOL. Additional research and supportive services meeting the informational and psychosocial needs of patients living with MBC are warranted.
Funding Metastatic Research Fund (anonymous donor), the Megan Lally Memorial Fund, the Nancy and Randy Berry Junior Faculty Award, the Karen Webster & David Evans Metastatic Research Fund, and the Susan G Komen for the Cure.
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Objective To describe the informational needs and QOL of patients with MBC within the first year of diagnosis, and to identify sociodemographic and medical factors that may be associated with informational needs and QOL.
Methods 52 patients (50 women, 2 men) enrolled within a year of diagnosis of MBC completed a cross-sectional, self-administered paper survey that included patient demographics, the Toronto Informational Needs Questionnaire-Breast Cancer (TINQ), the Hospital Anxiety and Depression Scale (HADS), and Medical Outcomes Study Short Form-36 (SF-36). High informational need was defined as a TINQ score of ≥ 200.
Results Of the total 52 patients, 69% (35/52) had high informational needs, 20% met the criteria for anxiety (HADS-Anxiety score, ≥ 11), and 8% met the criteria for depression. SF-36 scores were lower in all 8 subscales compared with the general population. Multivariate analyses showed that patients who were married or living as married (OR, 6.1; 95% CI, 1.4-28.9) and patients with de novo MBC (OR, 2.8; 95% CI, 0.5-14.3) or a shorter disease-free interval (DFI; < 5 years; OR, 24.2; 95% CI, 3.1-187.4) were more likely to have more informational needs (C statistic, 0.824) than were patients with a longer DFI (≥ 5 years).
Limitations This is a small cross-sectional study of a single academic institution.
Conclusion Patients with recently diagnosed MBC have high informational needs and decreased overall QOL. Additional research and supportive services meeting the informational and psychosocial needs of patients living with MBC are warranted.
Funding Metastatic Research Fund (anonymous donor), the Megan Lally Memorial Fund, the Nancy and Randy Berry Junior Faculty Award, the Karen Webster & David Evans Metastatic Research Fund, and the Susan G Komen for the Cure.
Click on the PDF icon at the top of this introduction to read the full article.
Objective To describe the informational needs and QOL of patients with MBC within the first year of diagnosis, and to identify sociodemographic and medical factors that may be associated with informational needs and QOL.
Methods 52 patients (50 women, 2 men) enrolled within a year of diagnosis of MBC completed a cross-sectional, self-administered paper survey that included patient demographics, the Toronto Informational Needs Questionnaire-Breast Cancer (TINQ), the Hospital Anxiety and Depression Scale (HADS), and Medical Outcomes Study Short Form-36 (SF-36). High informational need was defined as a TINQ score of ≥ 200.
Results Of the total 52 patients, 69% (35/52) had high informational needs, 20% met the criteria for anxiety (HADS-Anxiety score, ≥ 11), and 8% met the criteria for depression. SF-36 scores were lower in all 8 subscales compared with the general population. Multivariate analyses showed that patients who were married or living as married (OR, 6.1; 95% CI, 1.4-28.9) and patients with de novo MBC (OR, 2.8; 95% CI, 0.5-14.3) or a shorter disease-free interval (DFI; < 5 years; OR, 24.2; 95% CI, 3.1-187.4) were more likely to have more informational needs (C statistic, 0.824) than were patients with a longer DFI (≥ 5 years).
Limitations This is a small cross-sectional study of a single academic institution.
Conclusion Patients with recently diagnosed MBC have high informational needs and decreased overall QOL. Additional research and supportive services meeting the informational and psychosocial needs of patients living with MBC are warranted.
Funding Metastatic Research Fund (anonymous donor), the Megan Lally Memorial Fund, the Nancy and Randy Berry Junior Faculty Award, the Karen Webster & David Evans Metastatic Research Fund, and the Susan G Komen for the Cure.
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Turning back the clock: the increase in bilateral mastectomies
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David Henry's JCSO podcast, September 2014
Among the items featured in Dr David Henry’s monthly podcast for The Journal of Community and Supportive Oncology, is a report on bacteremia in adult cancer patients with apparently stable febrile neutropenia and another on practice gaps and barriers optimal care in patients with CML, ALL, or B-cell lymphomas. Also featured is a report on treatment patterns and clinical effectiveness in patients who are treated in the community setting for metastatic castrate-resistant prostate cancer after first-line docetaxel, as well as a Case Report on a patient with metastatic melanoma presenting as disseminated sporotrichosis.
Among the items featured in Dr David Henry’s monthly podcast for The Journal of Community and Supportive Oncology, is a report on bacteremia in adult cancer patients with apparently stable febrile neutropenia and another on practice gaps and barriers optimal care in patients with CML, ALL, or B-cell lymphomas. Also featured is a report on treatment patterns and clinical effectiveness in patients who are treated in the community setting for metastatic castrate-resistant prostate cancer after first-line docetaxel, as well as a Case Report on a patient with metastatic melanoma presenting as disseminated sporotrichosis.
Among the items featured in Dr David Henry’s monthly podcast for The Journal of Community and Supportive Oncology, is a report on bacteremia in adult cancer patients with apparently stable febrile neutropenia and another on practice gaps and barriers optimal care in patients with CML, ALL, or B-cell lymphomas. Also featured is a report on treatment patterns and clinical effectiveness in patients who are treated in the community setting for metastatic castrate-resistant prostate cancer after first-line docetaxel, as well as a Case Report on a patient with metastatic melanoma presenting as disseminated sporotrichosis.
VIDEO: CLEOPATRA combo extends survival in HER2-positive metastatic breast cancer
MADRID – The final overall survival analysis of the CLEOPATRA trial showed an unprecedented 15.7-month increase in overall survival for women with HER2-positive metastatic breast cancer.
The results were achieved by adding pertuzumab to first-line trastuzumab and docetaxel chemotherapy (56.5 months vs. 40.8 months; hazard ratio, 0.68; P = .0002).
Importantly, the survival improvement came without excessive toxicity, including cardiac events, lead author Dr. Sandra Swain reported during a presidential symposium at the European Society for Medical Oncology Congress.
The results, now with a median follow-up of 50 months, build on those previously reported from CLEOPATRA, showing a survival trend favoring the combination of two targeted agents with chemotherapy in the first interim analysis and a statistically significant overall survival advantage at 30 months in a second interim analysis.
In a video interview at the meeting, Dr. Swain, medical director of the Washington Cancer Institute, Medstar Washington Hospital Center, discusses the results and their implications for care.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
MADRID – The final overall survival analysis of the CLEOPATRA trial showed an unprecedented 15.7-month increase in overall survival for women with HER2-positive metastatic breast cancer.
The results were achieved by adding pertuzumab to first-line trastuzumab and docetaxel chemotherapy (56.5 months vs. 40.8 months; hazard ratio, 0.68; P = .0002).
Importantly, the survival improvement came without excessive toxicity, including cardiac events, lead author Dr. Sandra Swain reported during a presidential symposium at the European Society for Medical Oncology Congress.
The results, now with a median follow-up of 50 months, build on those previously reported from CLEOPATRA, showing a survival trend favoring the combination of two targeted agents with chemotherapy in the first interim analysis and a statistically significant overall survival advantage at 30 months in a second interim analysis.
In a video interview at the meeting, Dr. Swain, medical director of the Washington Cancer Institute, Medstar Washington Hospital Center, discusses the results and their implications for care.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
MADRID – The final overall survival analysis of the CLEOPATRA trial showed an unprecedented 15.7-month increase in overall survival for women with HER2-positive metastatic breast cancer.
The results were achieved by adding pertuzumab to first-line trastuzumab and docetaxel chemotherapy (56.5 months vs. 40.8 months; hazard ratio, 0.68; P = .0002).
Importantly, the survival improvement came without excessive toxicity, including cardiac events, lead author Dr. Sandra Swain reported during a presidential symposium at the European Society for Medical Oncology Congress.
The results, now with a median follow-up of 50 months, build on those previously reported from CLEOPATRA, showing a survival trend favoring the combination of two targeted agents with chemotherapy in the first interim analysis and a statistically significant overall survival advantage at 30 months in a second interim analysis.
In a video interview at the meeting, Dr. Swain, medical director of the Washington Cancer Institute, Medstar Washington Hospital Center, discusses the results and their implications for care.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
AT ESMO 2014
Key clinical point: CLEOPATRA establishes pertuzumab and trastuzumab plus chemotherapy as the standard of care in metastatic HER2-positive breast cancer.
Major finding: Overall survival was 40.8 months with trastuzumab plus chemotherapy, and 56.5 months with the addition of pertuzumab.
Data source: Phase III double-blind trial in 808 women with HER2-positive metastatic breast cancer.
Disclosures: The study was funded by Hoffman-La Roche, Genentech. Dr. Swain reported serving as an uncompensated consultant for Genentech/Roche. Her institution has received research funding from Genentech/Roche, Pfizer, Puma, Sanofi-Aventis, and Bristol-Myers Squibb. Several of her coauthors reported financial relationships with several drug firms.
Durable responses in metastatic melanoma, improved PFS in advanced colorectal cancer
High rate of durable responses to pembrolizumab in metastatic melanoma
Maintenance improves PFS in patients with metastatic colorectal cancer
Key clinical point Patients with metastatic colorectal cancer who have at least stable disease after induction chemotherapy may benefit from maintenance therapy with capecitabine and bevacizumab, though further studies on quality of life are needed. Major finding The median time to second progression (PFS2) for patients with metastatic colorectal cancer following induction and re-treatment was a median of 8.5 months for observation, compared with 11.7 months for maintenance with capecitabine and bevacizumab. Data source Randomized controlled trial of 588 patients from 64 hospitals in the Netherlands.
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High rate of durable responses to pembrolizumab in metastatic melanoma
Maintenance improves PFS in patients with metastatic colorectal cancer
Key clinical point Patients with metastatic colorectal cancer who have at least stable disease after induction chemotherapy may benefit from maintenance therapy with capecitabine and bevacizumab, though further studies on quality of life are needed. Major finding The median time to second progression (PFS2) for patients with metastatic colorectal cancer following induction and re-treatment was a median of 8.5 months for observation, compared with 11.7 months for maintenance with capecitabine and bevacizumab. Data source Randomized controlled trial of 588 patients from 64 hospitals in the Netherlands.
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High rate of durable responses to pembrolizumab in metastatic melanoma
Maintenance improves PFS in patients with metastatic colorectal cancer
Key clinical point Patients with metastatic colorectal cancer who have at least stable disease after induction chemotherapy may benefit from maintenance therapy with capecitabine and bevacizumab, though further studies on quality of life are needed. Major finding The median time to second progression (PFS2) for patients with metastatic colorectal cancer following induction and re-treatment was a median of 8.5 months for observation, compared with 11.7 months for maintenance with capecitabine and bevacizumab. Data source Randomized controlled trial of 588 patients from 64 hospitals in the Netherlands.
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Practice gaps and barriers to optimal care of hematologic malignancies in the United States
Objective To identify clinical challenges among hematologists and medical oncologists regarding the provision of care to patients with chronic myeloid leukemia (CML), acute lymphoblastic leukemia (ALL), or B-cell lymphomas.
Methods Hematologists and medical oncologists in active practice in the United States and who have a case load of ≥ 1 patient a year with CML, ALL, or B-cell lymphoma were recruited. The initial qualitative phase consisted of an online case-based survey followed by an interview exploring the contextual and behavioral factors that influence treatment decisions (n = 27). The analysis of qualitative data then informed a quantitative phase, in which 121 participants completed an online survey composed of case vignettes, multiple choice, and semantic differential rating scale questions. The respondents’ answers were compared with recommendations from treatment guidelines and faculty experts.
Results A higher frequency of bone marrow biopsies was reported compared with expert faculty recommendations by 74% of oncologists. Many respondents failed to recognize the clinical relevance of BCR-ABL mutations other than T315I. Respondents reported perceiving difficulties in individualizing treatment and interpreting response to treatment in patients with ALL and B-cell lymphomas. Fewer than 30% of respondents recognized the mechanisms of action of 5 of the 9 promising investigational agents presented.
Limitations Participant self-selection bias is a possibility because participation was voluntary. Practice gaps are not based on clinical data, but hypothetical case situations and self-report.
Conclusions Findings from this study can guide education to address the identified challenges in caring for patients with hematologic malignancies and improving patient care.
Funding This needs assessment was financially supported with an educational research grant from Pfizer Medical Education Group to the Annenberg Center for Health Sciences at Eisenhower.
Click on the PDF icon at the top of this introduction to read the full article.
Objective To identify clinical challenges among hematologists and medical oncologists regarding the provision of care to patients with chronic myeloid leukemia (CML), acute lymphoblastic leukemia (ALL), or B-cell lymphomas.
Methods Hematologists and medical oncologists in active practice in the United States and who have a case load of ≥ 1 patient a year with CML, ALL, or B-cell lymphoma were recruited. The initial qualitative phase consisted of an online case-based survey followed by an interview exploring the contextual and behavioral factors that influence treatment decisions (n = 27). The analysis of qualitative data then informed a quantitative phase, in which 121 participants completed an online survey composed of case vignettes, multiple choice, and semantic differential rating scale questions. The respondents’ answers were compared with recommendations from treatment guidelines and faculty experts.
Results A higher frequency of bone marrow biopsies was reported compared with expert faculty recommendations by 74% of oncologists. Many respondents failed to recognize the clinical relevance of BCR-ABL mutations other than T315I. Respondents reported perceiving difficulties in individualizing treatment and interpreting response to treatment in patients with ALL and B-cell lymphomas. Fewer than 30% of respondents recognized the mechanisms of action of 5 of the 9 promising investigational agents presented.
Limitations Participant self-selection bias is a possibility because participation was voluntary. Practice gaps are not based on clinical data, but hypothetical case situations and self-report.
Conclusions Findings from this study can guide education to address the identified challenges in caring for patients with hematologic malignancies and improving patient care.
Funding This needs assessment was financially supported with an educational research grant from Pfizer Medical Education Group to the Annenberg Center for Health Sciences at Eisenhower.
Click on the PDF icon at the top of this introduction to read the full article.
Objective To identify clinical challenges among hematologists and medical oncologists regarding the provision of care to patients with chronic myeloid leukemia (CML), acute lymphoblastic leukemia (ALL), or B-cell lymphomas.
Methods Hematologists and medical oncologists in active practice in the United States and who have a case load of ≥ 1 patient a year with CML, ALL, or B-cell lymphoma were recruited. The initial qualitative phase consisted of an online case-based survey followed by an interview exploring the contextual and behavioral factors that influence treatment decisions (n = 27). The analysis of qualitative data then informed a quantitative phase, in which 121 participants completed an online survey composed of case vignettes, multiple choice, and semantic differential rating scale questions. The respondents’ answers were compared with recommendations from treatment guidelines and faculty experts.
Results A higher frequency of bone marrow biopsies was reported compared with expert faculty recommendations by 74% of oncologists. Many respondents failed to recognize the clinical relevance of BCR-ABL mutations other than T315I. Respondents reported perceiving difficulties in individualizing treatment and interpreting response to treatment in patients with ALL and B-cell lymphomas. Fewer than 30% of respondents recognized the mechanisms of action of 5 of the 9 promising investigational agents presented.
Limitations Participant self-selection bias is a possibility because participation was voluntary. Practice gaps are not based on clinical data, but hypothetical case situations and self-report.
Conclusions Findings from this study can guide education to address the identified challenges in caring for patients with hematologic malignancies and improving patient care.
Funding This needs assessment was financially supported with an educational research grant from Pfizer Medical Education Group to the Annenberg Center for Health Sciences at Eisenhower.
Click on the PDF icon at the top of this introduction to read the full article.
Treatment patterns and clinical effectiveness in metastatic castrate resistant prostate cancer after first-line docetaxel
Objective To examine treatment patterns, sequencing, and outcomes in patients receiving second- and third-line treatment after first-line docetaxel.
Methods We used a community oncology database to identify patients who progressed after line 1 docetaxel (D) and received line 2 cabazitaxel (DC), abiraterone (DA), or other therapy (DO). Progression-free survival (PFS) and overall survival (OS) were assessed using Kaplan- Meier and Cox regression models. Line 3 included subsets DCA and DAC.
Results Line 2 groups (DC = 60 patients, DA = 71, DO = 153) did not differ significantly on demographic and clinical characteristics or median PFS on docetaxel therapy. Cox regression for OS by line 2 groups showed increased risk for DA compared with DC (HR, 1.69; P = .026) when 24 untreated DO patients were excluded. A similar nonsignificant pattern was observed when the 24 untreated patients were included. Of patients receiving DC in line 2, a nominally greater proportion received A in line 3 (57%, 34 of 60 patients) than did patients who received DA in line 2 followed by C in line 3 (25%, 18 of 71).
Limitations There was a small sample for line 3, and unexamined confounds and selection biases in observational research. Conclusions Treatment patterns in community settings following docetaxel are complex and may involve multiple hormonal agents prior to disease progression. Cabazitaxel may not be optimally used in advanced disease. Although Cox regression showed increased risk of death for DA compared with DC, results need to be validated prospectively.
Funding and disclosures This study was funded by Sanof US LLC. Dr Hennessy and Mr Thompson are employed by Sanof. Dr Hennessy holds restricted stock units and company stock in Sanof. Dr Nicacio was previously employed by Sanof. Drs Houts, Walker, and Miller’s institution is receiving research funding from Sanof for other research projects. Dr Walker’s institution received honoraria and travel expenses for his previous advisory board participation. Dr Somer declares no conflicts.
Click on the PDF icon at the top of this introduction to read the full article.
Objective To examine treatment patterns, sequencing, and outcomes in patients receiving second- and third-line treatment after first-line docetaxel.
Methods We used a community oncology database to identify patients who progressed after line 1 docetaxel (D) and received line 2 cabazitaxel (DC), abiraterone (DA), or other therapy (DO). Progression-free survival (PFS) and overall survival (OS) were assessed using Kaplan- Meier and Cox regression models. Line 3 included subsets DCA and DAC.
Results Line 2 groups (DC = 60 patients, DA = 71, DO = 153) did not differ significantly on demographic and clinical characteristics or median PFS on docetaxel therapy. Cox regression for OS by line 2 groups showed increased risk for DA compared with DC (HR, 1.69; P = .026) when 24 untreated DO patients were excluded. A similar nonsignificant pattern was observed when the 24 untreated patients were included. Of patients receiving DC in line 2, a nominally greater proportion received A in line 3 (57%, 34 of 60 patients) than did patients who received DA in line 2 followed by C in line 3 (25%, 18 of 71).
Limitations There was a small sample for line 3, and unexamined confounds and selection biases in observational research. Conclusions Treatment patterns in community settings following docetaxel are complex and may involve multiple hormonal agents prior to disease progression. Cabazitaxel may not be optimally used in advanced disease. Although Cox regression showed increased risk of death for DA compared with DC, results need to be validated prospectively.
Funding and disclosures This study was funded by Sanof US LLC. Dr Hennessy and Mr Thompson are employed by Sanof. Dr Hennessy holds restricted stock units and company stock in Sanof. Dr Nicacio was previously employed by Sanof. Drs Houts, Walker, and Miller’s institution is receiving research funding from Sanof for other research projects. Dr Walker’s institution received honoraria and travel expenses for his previous advisory board participation. Dr Somer declares no conflicts.
Click on the PDF icon at the top of this introduction to read the full article.
Objective To examine treatment patterns, sequencing, and outcomes in patients receiving second- and third-line treatment after first-line docetaxel.
Methods We used a community oncology database to identify patients who progressed after line 1 docetaxel (D) and received line 2 cabazitaxel (DC), abiraterone (DA), or other therapy (DO). Progression-free survival (PFS) and overall survival (OS) were assessed using Kaplan- Meier and Cox regression models. Line 3 included subsets DCA and DAC.
Results Line 2 groups (DC = 60 patients, DA = 71, DO = 153) did not differ significantly on demographic and clinical characteristics or median PFS on docetaxel therapy. Cox regression for OS by line 2 groups showed increased risk for DA compared with DC (HR, 1.69; P = .026) when 24 untreated DO patients were excluded. A similar nonsignificant pattern was observed when the 24 untreated patients were included. Of patients receiving DC in line 2, a nominally greater proportion received A in line 3 (57%, 34 of 60 patients) than did patients who received DA in line 2 followed by C in line 3 (25%, 18 of 71).
Limitations There was a small sample for line 3, and unexamined confounds and selection biases in observational research. Conclusions Treatment patterns in community settings following docetaxel are complex and may involve multiple hormonal agents prior to disease progression. Cabazitaxel may not be optimally used in advanced disease. Although Cox regression showed increased risk of death for DA compared with DC, results need to be validated prospectively.
Funding and disclosures This study was funded by Sanof US LLC. Dr Hennessy and Mr Thompson are employed by Sanof. Dr Hennessy holds restricted stock units and company stock in Sanof. Dr Nicacio was previously employed by Sanof. Drs Houts, Walker, and Miller’s institution is receiving research funding from Sanof for other research projects. Dr Walker’s institution received honoraria and travel expenses for his previous advisory board participation. Dr Somer declares no conflicts.
Click on the PDF icon at the top of this introduction to read the full article.
Bacteremia in adult cancer patients with apparently stable febrile neutropenia: data from a cohort of 692 consecutive episodes from a single institution
Background Bacteremia is associated with increased risk of complications in patients with febrile neutropenia (FN), although few clinical studies have reported outcomes in apparently stable patients (ASPs) who could be candidates for home treatment.
Objective To assess the risk factors and the impact of bacteremia in ASPs.
Methods We retrospectively analyzed 861 consecutive episodes of FN that were classified according to their presentation into 2 categories: clearly unstable patients and ASPs. We estimated the incidence of bacteremia and severe complications in ASPs. We analyzed predictors for bacteremia and the discriminatory ability of the MASCC score in this setting.
Results We classified 692 episodes as ASPs. Bacteremia occurred in 6%, major complications were noted in 7.3%, and death occurred in 1.3%. Patients with bacteremia had more complications (odds ratio [OR], 8.2), and mortality (OR, 8.2). The integration of the MASCC score and bacteremic status predicted complications with an area under the receiver operating characteristic (ROC) curve of 0.74, sensitivity of 36%, and specificity of 94%. Predictors of bacteremia were temperature ≥ 39°C/102.2°F (OR, 3), rigors (OR, 2.2), ECOG PS ≥ 2 (OR, 2.1), and advanced cancer (OR, 2.5). Two percent of patients who remained afebrile for 48 hours had positive blood cultures afterward.
Limitations A single-center, retrospective analysis, and the absence of a validation set to test the model’s discriminatory ability.
Conclusions Bacteremia is infrequent among ASPs but is associated with a high risk of complications. We identified several variables that could improve the prognostic classification of clinically stable FN.
Click on the PDF icon at the top of this introduction to read the full article.
Background Bacteremia is associated with increased risk of complications in patients with febrile neutropenia (FN), although few clinical studies have reported outcomes in apparently stable patients (ASPs) who could be candidates for home treatment.
Objective To assess the risk factors and the impact of bacteremia in ASPs.
Methods We retrospectively analyzed 861 consecutive episodes of FN that were classified according to their presentation into 2 categories: clearly unstable patients and ASPs. We estimated the incidence of bacteremia and severe complications in ASPs. We analyzed predictors for bacteremia and the discriminatory ability of the MASCC score in this setting.
Results We classified 692 episodes as ASPs. Bacteremia occurred in 6%, major complications were noted in 7.3%, and death occurred in 1.3%. Patients with bacteremia had more complications (odds ratio [OR], 8.2), and mortality (OR, 8.2). The integration of the MASCC score and bacteremic status predicted complications with an area under the receiver operating characteristic (ROC) curve of 0.74, sensitivity of 36%, and specificity of 94%. Predictors of bacteremia were temperature ≥ 39°C/102.2°F (OR, 3), rigors (OR, 2.2), ECOG PS ≥ 2 (OR, 2.1), and advanced cancer (OR, 2.5). Two percent of patients who remained afebrile for 48 hours had positive blood cultures afterward.
Limitations A single-center, retrospective analysis, and the absence of a validation set to test the model’s discriminatory ability.
Conclusions Bacteremia is infrequent among ASPs but is associated with a high risk of complications. We identified several variables that could improve the prognostic classification of clinically stable FN.
Click on the PDF icon at the top of this introduction to read the full article.
Background Bacteremia is associated with increased risk of complications in patients with febrile neutropenia (FN), although few clinical studies have reported outcomes in apparently stable patients (ASPs) who could be candidates for home treatment.
Objective To assess the risk factors and the impact of bacteremia in ASPs.
Methods We retrospectively analyzed 861 consecutive episodes of FN that were classified according to their presentation into 2 categories: clearly unstable patients and ASPs. We estimated the incidence of bacteremia and severe complications in ASPs. We analyzed predictors for bacteremia and the discriminatory ability of the MASCC score in this setting.
Results We classified 692 episodes as ASPs. Bacteremia occurred in 6%, major complications were noted in 7.3%, and death occurred in 1.3%. Patients with bacteremia had more complications (odds ratio [OR], 8.2), and mortality (OR, 8.2). The integration of the MASCC score and bacteremic status predicted complications with an area under the receiver operating characteristic (ROC) curve of 0.74, sensitivity of 36%, and specificity of 94%. Predictors of bacteremia were temperature ≥ 39°C/102.2°F (OR, 3), rigors (OR, 2.2), ECOG PS ≥ 2 (OR, 2.1), and advanced cancer (OR, 2.5). Two percent of patients who remained afebrile for 48 hours had positive blood cultures afterward.
Limitations A single-center, retrospective analysis, and the absence of a validation set to test the model’s discriminatory ability.
Conclusions Bacteremia is infrequent among ASPs but is associated with a high risk of complications. We identified several variables that could improve the prognostic classification of clinically stable FN.
Click on the PDF icon at the top of this introduction to read the full article.
The art and science of cancer care
Summer is winding down as we go to press with this month’s issue, and while we might well reflect a little sadly on its departure, we can also look forward to the fall season with its promise of renewal and adventure. As I settled back in to my familiar work routine after the Labor Day weekend, I was reminded of how, despite the remarkable clinical advances in oncology, we are still caregivers, involved in our patients’ everyday lives and that we can never forget our humanity. The advent of high-tech personalized medicine or precision oncology, as I prefer to call it, has given oncologists a remarkable cache of treatment options for their patients and the hope that more – and better – therapies are to come. Next-generation diagnostics are helping us identify the cellular targets we need to take aim at to kill the tumor and globally, research is yielding more and more therapeutics to subdue those targets and hence the tumor.
Click on the PDF icon at the top of this introduction to read the full article.
Summer is winding down as we go to press with this month’s issue, and while we might well reflect a little sadly on its departure, we can also look forward to the fall season with its promise of renewal and adventure. As I settled back in to my familiar work routine after the Labor Day weekend, I was reminded of how, despite the remarkable clinical advances in oncology, we are still caregivers, involved in our patients’ everyday lives and that we can never forget our humanity. The advent of high-tech personalized medicine or precision oncology, as I prefer to call it, has given oncologists a remarkable cache of treatment options for their patients and the hope that more – and better – therapies are to come. Next-generation diagnostics are helping us identify the cellular targets we need to take aim at to kill the tumor and globally, research is yielding more and more therapeutics to subdue those targets and hence the tumor.
Click on the PDF icon at the top of this introduction to read the full article.
Summer is winding down as we go to press with this month’s issue, and while we might well reflect a little sadly on its departure, we can also look forward to the fall season with its promise of renewal and adventure. As I settled back in to my familiar work routine after the Labor Day weekend, I was reminded of how, despite the remarkable clinical advances in oncology, we are still caregivers, involved in our patients’ everyday lives and that we can never forget our humanity. The advent of high-tech personalized medicine or precision oncology, as I prefer to call it, has given oncologists a remarkable cache of treatment options for their patients and the hope that more – and better – therapies are to come. Next-generation diagnostics are helping us identify the cellular targets we need to take aim at to kill the tumor and globally, research is yielding more and more therapeutics to subdue those targets and hence the tumor.
Click on the PDF icon at the top of this introduction to read the full article.
VIDEO: Breast cancer symposium take-home messages, Day 1
SAN FRANCISCO – Dr. Eleftherios (Terry) Mamounas reviews the first day of the annual breast cancer symposium sponsored by the American Society of Clinical Oncology.
Key sessions covered the increasingly complex topic of genetic risk assessment and stirred up the debate about management of ductal carcinoma in situ (DCIS). Dr. Mamounas, professor of surgery at the University of Central Florida and medical director of the comprehensive breast program at the University of Florida Health Cancer Center, both in Orlando, discusses the significance of atypical hyperplasia, including new data suggesting that the fourfold increased risk of developing breast cancer in women with ductal carcinoma in situ (DCIS) is not further worsened by having a family history of DCIS.
Among the top oral presentations, one study suggested that a nomogram helped predict the risk of locoregional recurrence in patients treated for breast cancer using accelerated partial-breast irradiation. Another study examined the effect of hormone receptor status and local treatment on overall survival for patients with early-stage breast cancer.
Dr. Mamounas also discusses his own study, which he presented at the meeting, showing lower rates of locoregional recurrence in patients who have a pathologic complete response to neoadjuvant therapy. He puts the findings in context with tips on how to incorporate pathologic complete response data into clinical practice.
A separate study reported some of the first data on complication rates after unilateral or bilateral mastectomy and reconstruction. Dr. Mamounas wraps up the day’s review by discussing sessions on the effect of luteinizing hormone-releasing hormone agonists during chemotherapy in preserving ovarian function, and on breast cancer prevention, including the use of aromatase inhibitors.
For more of the meeting’s highlights, see our video interviews with Dr. Hope S. Rugo discussing the events of the second and third days of the Breast Cancer Symposium. Dr. Rugo is director of the Breast Oncology Clinical Trials Program at the University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center.
Dr. Mamounas reported financial associations with Genomic Health, Genentech/Roche, Pfizer, GlaxoSmithKline, Eisai, Celgene, and GE Healthcare.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
On Twitter @sherryboschert
SAN FRANCISCO – Dr. Eleftherios (Terry) Mamounas reviews the first day of the annual breast cancer symposium sponsored by the American Society of Clinical Oncology.
Key sessions covered the increasingly complex topic of genetic risk assessment and stirred up the debate about management of ductal carcinoma in situ (DCIS). Dr. Mamounas, professor of surgery at the University of Central Florida and medical director of the comprehensive breast program at the University of Florida Health Cancer Center, both in Orlando, discusses the significance of atypical hyperplasia, including new data suggesting that the fourfold increased risk of developing breast cancer in women with ductal carcinoma in situ (DCIS) is not further worsened by having a family history of DCIS.
Among the top oral presentations, one study suggested that a nomogram helped predict the risk of locoregional recurrence in patients treated for breast cancer using accelerated partial-breast irradiation. Another study examined the effect of hormone receptor status and local treatment on overall survival for patients with early-stage breast cancer.
Dr. Mamounas also discusses his own study, which he presented at the meeting, showing lower rates of locoregional recurrence in patients who have a pathologic complete response to neoadjuvant therapy. He puts the findings in context with tips on how to incorporate pathologic complete response data into clinical practice.
A separate study reported some of the first data on complication rates after unilateral or bilateral mastectomy and reconstruction. Dr. Mamounas wraps up the day’s review by discussing sessions on the effect of luteinizing hormone-releasing hormone agonists during chemotherapy in preserving ovarian function, and on breast cancer prevention, including the use of aromatase inhibitors.
For more of the meeting’s highlights, see our video interviews with Dr. Hope S. Rugo discussing the events of the second and third days of the Breast Cancer Symposium. Dr. Rugo is director of the Breast Oncology Clinical Trials Program at the University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center.
Dr. Mamounas reported financial associations with Genomic Health, Genentech/Roche, Pfizer, GlaxoSmithKline, Eisai, Celgene, and GE Healthcare.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
On Twitter @sherryboschert
SAN FRANCISCO – Dr. Eleftherios (Terry) Mamounas reviews the first day of the annual breast cancer symposium sponsored by the American Society of Clinical Oncology.
Key sessions covered the increasingly complex topic of genetic risk assessment and stirred up the debate about management of ductal carcinoma in situ (DCIS). Dr. Mamounas, professor of surgery at the University of Central Florida and medical director of the comprehensive breast program at the University of Florida Health Cancer Center, both in Orlando, discusses the significance of atypical hyperplasia, including new data suggesting that the fourfold increased risk of developing breast cancer in women with ductal carcinoma in situ (DCIS) is not further worsened by having a family history of DCIS.
Among the top oral presentations, one study suggested that a nomogram helped predict the risk of locoregional recurrence in patients treated for breast cancer using accelerated partial-breast irradiation. Another study examined the effect of hormone receptor status and local treatment on overall survival for patients with early-stage breast cancer.
Dr. Mamounas also discusses his own study, which he presented at the meeting, showing lower rates of locoregional recurrence in patients who have a pathologic complete response to neoadjuvant therapy. He puts the findings in context with tips on how to incorporate pathologic complete response data into clinical practice.
A separate study reported some of the first data on complication rates after unilateral or bilateral mastectomy and reconstruction. Dr. Mamounas wraps up the day’s review by discussing sessions on the effect of luteinizing hormone-releasing hormone agonists during chemotherapy in preserving ovarian function, and on breast cancer prevention, including the use of aromatase inhibitors.
For more of the meeting’s highlights, see our video interviews with Dr. Hope S. Rugo discussing the events of the second and third days of the Breast Cancer Symposium. Dr. Rugo is director of the Breast Oncology Clinical Trials Program at the University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center.
Dr. Mamounas reported financial associations with Genomic Health, Genentech/Roche, Pfizer, GlaxoSmithKline, Eisai, Celgene, and GE Healthcare.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
On Twitter @sherryboschert
AT THE ASCO BREAST CANCER SYMPOSIUM
