Patient & Survivor Care

Background Reproductive-age women who are undergoing cancer treatment are at risk for heavy menstrual bleeding, unintended pregnancy, and have a contraindication to estrogen-containing products. The incidence of vaginal bleeding and contraception use is not known.

Objective To describe clinical practices regarding menstrual suppression, estimate the incidence of vaginal bleeding complaints, and investigate contraceptive counseling and provision in women undergoing chemotherapy.

Methods We performed a chart review using ICD-9 codes to identify women aged 14-40 years who received chemotherapy at our institution during July 2008-June 2013. Electronic medical records were examined for menstrual suppression therapy, contraception counseling, and abnormal vaginal bleeding.

Results We identified 137 women for this study. 24 (18%) received prophylactic menstrual suppression counseling, of whom 17 (71%) initiated treatment, primarily with combined oral contraceptives, all prescribed by hematologist-oncologists. During the first 6 months of chemotherapy, 36 women (26%) complained of abnormal vaginal bleeding, including 10 women who were on prophylactic treatment. 19 women noted moderate to severe bleeding. 11 (12%) women received contraceptive counseling before chemotherapy, all from hematologist-oncologists; 86 women (63%) initiated chemotherapy without a documented contraceptive method.

Limitations Data were generated from billing codes, so all eligible women may not have been included.

Conclusions Reproductive-age women undergoing chemotherapy may not receive adequate contraception and menstrual suppression counseling. We encourage consulting gynecologists, especially family planning specialists, at the time of cancer diagnosis to support women with decisions about menstrual suppression and contraception.

Funding/sponsorship Society of Family Planning, National Center for Advancing Translational Sciences, National Institutes of Health, Lillian Mae Rapp Research Endowment

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

Background Reproductive-age women who are undergoing cancer treatment are at risk for heavy menstrual bleeding, unintended pregnancy, and have a contraindication to estrogen-containing products. The incidence of vaginal bleeding and contraception use is not known.

Objective To describe clinical practices regarding menstrual suppression, estimate the incidence of vaginal bleeding complaints, and investigate contraceptive counseling and provision in women undergoing chemotherapy.

Methods We performed a chart review using ICD-9 codes to identify women aged 14-40 years who received chemotherapy at our institution during July 2008-June 2013. Electronic medical records were examined for menstrual suppression therapy, contraception counseling, and abnormal vaginal bleeding.

Results We identified 137 women for this study. 24 (18%) received prophylactic menstrual suppression counseling, of whom 17 (71%) initiated treatment, primarily with combined oral contraceptives, all prescribed by hematologist-oncologists. During the first 6 months of chemotherapy, 36 women (26%) complained of abnormal vaginal bleeding, including 10 women who were on prophylactic treatment. 19 women noted moderate to severe bleeding. 11 (12%) women received contraceptive counseling before chemotherapy, all from hematologist-oncologists; 86 women (63%) initiated chemotherapy without a documented contraceptive method.

Limitations Data were generated from billing codes, so all eligible women may not have been included.

Conclusions Reproductive-age women undergoing chemotherapy may not receive adequate contraception and menstrual suppression counseling. We encourage consulting gynecologists, especially family planning specialists, at the time of cancer diagnosis to support women with decisions about menstrual suppression and contraception.

Funding/sponsorship Society of Family Planning, National Center for Advancing Translational Sciences, National Institutes of Health, Lillian Mae Rapp Research Endowment

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

Background Reproductive-age women who are undergoing cancer treatment are at risk for heavy menstrual bleeding, unintended pregnancy, and have a contraindication to estrogen-containing products. The incidence of vaginal bleeding and contraception use is not known.

Objective To describe clinical practices regarding menstrual suppression, estimate the incidence of vaginal bleeding complaints, and investigate contraceptive counseling and provision in women undergoing chemotherapy.

Methods We performed a chart review using ICD-9 codes to identify women aged 14-40 years who received chemotherapy at our institution during July 2008-June 2013. Electronic medical records were examined for menstrual suppression therapy, contraception counseling, and abnormal vaginal bleeding.

Results We identified 137 women for this study. 24 (18%) received prophylactic menstrual suppression counseling, of whom 17 (71%) initiated treatment, primarily with combined oral contraceptives, all prescribed by hematologist-oncologists. During the first 6 months of chemotherapy, 36 women (26%) complained of abnormal vaginal bleeding, including 10 women who were on prophylactic treatment. 19 women noted moderate to severe bleeding. 11 (12%) women received contraceptive counseling before chemotherapy, all from hematologist-oncologists; 86 women (63%) initiated chemotherapy without a documented contraceptive method.

Limitations Data were generated from billing codes, so all eligible women may not have been included.

Conclusions Reproductive-age women undergoing chemotherapy may not receive adequate contraception and menstrual suppression counseling. We encourage consulting gynecologists, especially family planning specialists, at the time of cancer diagnosis to support women with decisions about menstrual suppression and contraception.

Funding/sponsorship Society of Family Planning, National Center for Advancing Translational Sciences, National Institutes of Health, Lillian Mae Rapp Research Endowment

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

Fluorouracil or 5-fluorouracil (5-FU) is an effective cytotoxic drug that is incorporated into various chemotherapeutic regimens for the treatment of numerous tumor types, but its clinical utility is limited by its narrow therapeutic index and the risk of overdose and serious toxic effects. Until recently, these outcomes were managed with supportive care, but the approval of uridine triacetate provides an antidote to reverse 5-FU-associated toxicity, to prevent death and potentially allow some patients to resume chemotherapy.

Fluorouracil or 5-fluorouracil (5-FU) is an effective cytotoxic drug that is incorporated into various chemotherapeutic regimens for the treatment of numerous tumor types, but its clinical utility is limited by its narrow therapeutic index and the risk of overdose and serious toxic effects. Until recently, these outcomes were managed with supportive care, but the approval of uridine triacetate provides an antidote to reverse 5-FU-associated toxicity, to prevent death and potentially allow some patients to resume chemotherapy.

Fluorouracil or 5-fluorouracil (5-FU) is an effective cytotoxic drug that is incorporated into various chemotherapeutic regimens for the treatment of numerous tumor types, but its clinical utility is limited by its narrow therapeutic index and the risk of overdose and serious toxic effects. Until recently, these outcomes were managed with supportive care, but the approval of uridine triacetate provides an antidote to reverse 5-FU-associated toxicity, to prevent death and potentially allow some patients to resume chemotherapy.

Protective treatment with the GnRH agonist triptorelin failed to prevent chemotherapy-induced premature ovarian failure in young women with lymphoma, according to a report published in the Journal of Clinical Oncology.

This type of protective therapy has been used for at least 20 years but is still controversial. Some clinical practice guidelines endorse the practice, but others do not. The evidence is both sparse and ambiguous, said Isabelle Demeestere, MD, of the research laboratory on human reproduction, Université Libre de Bruxelles (Belgium), and her associates.

In what they described as “the first randomized clinical trial providing accurate information on ovarian function and fertility after a median of 5 years of follow-up,” the investigators assessed 67 young women (median age, 26 years) treated for Hodgkin’s or non-Hodgkin’s lymphoma at 15 cancer centers in France, Belgium, and Italy. These patients had been randomly assigned to receive chemotherapy plus triptorelin (32 women) or chemotherapy plus placebo injections (35 women) at baseline.

Premature ovarian failure, as measured by elevated FSH levels, occurred in six of the GnRH group and eight of the control group, a nonsignificant difference. Moreover, the rate of recovery of ovarian function, as measured by at least one FSH level of 15 IU/L or less, was the same between the two study groups. And 17 women (53%) in the GnRH group eventually achieved pregnancy, which is not significantly different from the 43% pregnancy rate in the control group (15 of 35 women).

Five women – two in the GnRH group and three in the control group – achieved pregnancy during long-term follow-up, even though they had been classified as having premature ovarian failure. This “confirms the possibility of incidental ovarian cycle recovery, leading to fertility restoration several years after treatment in this young population,” Dr. Demeestere and her associates wrote (J Clin Oncol. 2016. [doi:10.1200/JCO.2015.65.884]).

The study findings “suggest caution” regarding guidelines that recommend using GnRH agonists to preserve fertility in young women undergoing chemotherapy, they added.

Protective treatment with the GnRH agonist triptorelin failed to prevent chemotherapy-induced premature ovarian failure in young women with lymphoma, according to a report published in the Journal of Clinical Oncology.

This type of protective therapy has been used for at least 20 years but is still controversial. Some clinical practice guidelines endorse the practice, but others do not. The evidence is both sparse and ambiguous, said Isabelle Demeestere, MD, of the research laboratory on human reproduction, Université Libre de Bruxelles (Belgium), and her associates.

In what they described as “the first randomized clinical trial providing accurate information on ovarian function and fertility after a median of 5 years of follow-up,” the investigators assessed 67 young women (median age, 26 years) treated for Hodgkin’s or non-Hodgkin’s lymphoma at 15 cancer centers in France, Belgium, and Italy. These patients had been randomly assigned to receive chemotherapy plus triptorelin (32 women) or chemotherapy plus placebo injections (35 women) at baseline.

Premature ovarian failure, as measured by elevated FSH levels, occurred in six of the GnRH group and eight of the control group, a nonsignificant difference. Moreover, the rate of recovery of ovarian function, as measured by at least one FSH level of 15 IU/L or less, was the same between the two study groups. And 17 women (53%) in the GnRH group eventually achieved pregnancy, which is not significantly different from the 43% pregnancy rate in the control group (15 of 35 women).

Five women – two in the GnRH group and three in the control group – achieved pregnancy during long-term follow-up, even though they had been classified as having premature ovarian failure. This “confirms the possibility of incidental ovarian cycle recovery, leading to fertility restoration several years after treatment in this young population,” Dr. Demeestere and her associates wrote (J Clin Oncol. 2016. [doi:10.1200/JCO.2015.65.884]).

The study findings “suggest caution” regarding guidelines that recommend using GnRH agonists to preserve fertility in young women undergoing chemotherapy, they added.

Protective treatment with the GnRH agonist triptorelin failed to prevent chemotherapy-induced premature ovarian failure in young women with lymphoma, according to a report published in the Journal of Clinical Oncology.

This type of protective therapy has been used for at least 20 years but is still controversial. Some clinical practice guidelines endorse the practice, but others do not. The evidence is both sparse and ambiguous, said Isabelle Demeestere, MD, of the research laboratory on human reproduction, Université Libre de Bruxelles (Belgium), and her associates.

In what they described as “the first randomized clinical trial providing accurate information on ovarian function and fertility after a median of 5 years of follow-up,” the investigators assessed 67 young women (median age, 26 years) treated for Hodgkin’s or non-Hodgkin’s lymphoma at 15 cancer centers in France, Belgium, and Italy. These patients had been randomly assigned to receive chemotherapy plus triptorelin (32 women) or chemotherapy plus placebo injections (35 women) at baseline.

Premature ovarian failure, as measured by elevated FSH levels, occurred in six of the GnRH group and eight of the control group, a nonsignificant difference. Moreover, the rate of recovery of ovarian function, as measured by at least one FSH level of 15 IU/L or less, was the same between the two study groups. And 17 women (53%) in the GnRH group eventually achieved pregnancy, which is not significantly different from the 43% pregnancy rate in the control group (15 of 35 women).

Five women – two in the GnRH group and three in the control group – achieved pregnancy during long-term follow-up, even though they had been classified as having premature ovarian failure. This “confirms the possibility of incidental ovarian cycle recovery, leading to fertility restoration several years after treatment in this young population,” Dr. Demeestere and her associates wrote (J Clin Oncol. 2016. [doi:10.1200/JCO.2015.65.884]).

The study findings “suggest caution” regarding guidelines that recommend using GnRH agonists to preserve fertility in young women undergoing chemotherapy, they added.

From 1997 to 2014, cancer survivors had a significantly faster increase in obesity prevalence compared with adults without a history of cancer, investigators found.

Furthermore, the elevated annual increase in rates of obesity was more pronounced in women, in breast and colorectal cancer survivors, and in non-Hispanic blacks.

©SandraMatic/Thinkstock

Cancer patients may be at an increased risk for weight gain caused by specific cancer treatments such as chemotherapy, steroid modifications, and various hormone therapies, especially in “hormonally and metabolically driven cancers such as breast and colorectal cancer,” wrote Heather Greenlee, ND, PhD, of Columbia University, New York, and her associates (J Clin Oncol. 2016 July 25. doi: 10.1200/JCO.2016.66.4391). “To better inform future research on obesity and cancer survival and to inform the planning and implementation of weight loss interventions in cancer survivors, we compared trends from 1997 to 2014 in obesity prevalence in U.S. adults with and without a history of cancer,” the researchers explained.

Obesity prevalence and trends were evaluated through the National Health Interview Survey, an ongoing cross-sectional survey of the health status, health care access, and behaviors of the U.S. civilian population conducted by the National Center for Health Statistics.

For the current study, surveys from a total of 538,969 adults aged 18-85 years with (n = 32,447) or without (n = 506,522) a history of cancer were analyzed. Participants provided self-reported height and weight measures from which body mass index was calculated. Obesity was defined as a BMI of 30 kg/m² or higher for non-Asians and 27.5 kg/m² or higher for Asians. Participants also self-reported sex, race, and cancer history.

Overall, the prevalence of obesity consistently increased from 1997 to 2014. Among cancer survivors, the prevalence of obesity increased from 22.4% to 31.7% while in adults without a history of cancer, prevalence increased from 20.9% to 29.5%.

The annual increase in the rate of obesity was significantly greater in both women and men with a history of cancer (2.9% and 2.8% respectively) compared with those without a history of cancer (2.3% and 2.4%, P less than .001 for all).

The elevated annual increase in rates of obesity was even higher in colorectal (3.1% in women and 3.7% in men) and breast (3.0%) cancer survivors compared with adults without a history of cancer, but was lower in prostate cancer survivors (2.1%; P = .001 for all).

“These findings call for public health planning of effective and scalable weight management and control programs for cancer survivors, especially for breast and colorectal cancer survivors and for non-Hispanic blacks,” the investigators concluded.

The National Cancer Institute funded the study. Dr. Greenlee and one other investigator reported serving in advisory roles for EHE International.

[email protected]

On Twitter @jessnicolecraig

From 1997 to 2014, cancer survivors had a significantly faster increase in obesity prevalence compared with adults without a history of cancer, investigators found.

Furthermore, the elevated annual increase in rates of obesity was more pronounced in women, in breast and colorectal cancer survivors, and in non-Hispanic blacks.

©SandraMatic/Thinkstock

Cancer patients may be at an increased risk for weight gain caused by specific cancer treatments such as chemotherapy, steroid modifications, and various hormone therapies, especially in “hormonally and metabolically driven cancers such as breast and colorectal cancer,” wrote Heather Greenlee, ND, PhD, of Columbia University, New York, and her associates (J Clin Oncol. 2016 July 25. doi: 10.1200/JCO.2016.66.4391). “To better inform future research on obesity and cancer survival and to inform the planning and implementation of weight loss interventions in cancer survivors, we compared trends from 1997 to 2014 in obesity prevalence in U.S. adults with and without a history of cancer,” the researchers explained.

Obesity prevalence and trends were evaluated through the National Health Interview Survey, an ongoing cross-sectional survey of the health status, health care access, and behaviors of the U.S. civilian population conducted by the National Center for Health Statistics.

For the current study, surveys from a total of 538,969 adults aged 18-85 years with (n = 32,447) or without (n = 506,522) a history of cancer were analyzed. Participants provided self-reported height and weight measures from which body mass index was calculated. Obesity was defined as a BMI of 30 kg/m² or higher for non-Asians and 27.5 kg/m² or higher for Asians. Participants also self-reported sex, race, and cancer history.

Overall, the prevalence of obesity consistently increased from 1997 to 2014. Among cancer survivors, the prevalence of obesity increased from 22.4% to 31.7% while in adults without a history of cancer, prevalence increased from 20.9% to 29.5%.

The annual increase in the rate of obesity was significantly greater in both women and men with a history of cancer (2.9% and 2.8% respectively) compared with those without a history of cancer (2.3% and 2.4%, P less than .001 for all).

The elevated annual increase in rates of obesity was even higher in colorectal (3.1% in women and 3.7% in men) and breast (3.0%) cancer survivors compared with adults without a history of cancer, but was lower in prostate cancer survivors (2.1%; P = .001 for all).

“These findings call for public health planning of effective and scalable weight management and control programs for cancer survivors, especially for breast and colorectal cancer survivors and for non-Hispanic blacks,” the investigators concluded.

The National Cancer Institute funded the study. Dr. Greenlee and one other investigator reported serving in advisory roles for EHE International.

[email protected]

On Twitter @jessnicolecraig

From 1997 to 2014, cancer survivors had a significantly faster increase in obesity prevalence compared with adults without a history of cancer, investigators found.

Furthermore, the elevated annual increase in rates of obesity was more pronounced in women, in breast and colorectal cancer survivors, and in non-Hispanic blacks.

©SandraMatic/Thinkstock

Cancer patients may be at an increased risk for weight gain caused by specific cancer treatments such as chemotherapy, steroid modifications, and various hormone therapies, especially in “hormonally and metabolically driven cancers such as breast and colorectal cancer,” wrote Heather Greenlee, ND, PhD, of Columbia University, New York, and her associates (J Clin Oncol. 2016 July 25. doi: 10.1200/JCO.2016.66.4391). “To better inform future research on obesity and cancer survival and to inform the planning and implementation of weight loss interventions in cancer survivors, we compared trends from 1997 to 2014 in obesity prevalence in U.S. adults with and without a history of cancer,” the researchers explained.

Obesity prevalence and trends were evaluated through the National Health Interview Survey, an ongoing cross-sectional survey of the health status, health care access, and behaviors of the U.S. civilian population conducted by the National Center for Health Statistics.

For the current study, surveys from a total of 538,969 adults aged 18-85 years with (n = 32,447) or without (n = 506,522) a history of cancer were analyzed. Participants provided self-reported height and weight measures from which body mass index was calculated. Obesity was defined as a BMI of 30 kg/m² or higher for non-Asians and 27.5 kg/m² or higher for Asians. Participants also self-reported sex, race, and cancer history.

Overall, the prevalence of obesity consistently increased from 1997 to 2014. Among cancer survivors, the prevalence of obesity increased from 22.4% to 31.7% while in adults without a history of cancer, prevalence increased from 20.9% to 29.5%.

The annual increase in the rate of obesity was significantly greater in both women and men with a history of cancer (2.9% and 2.8% respectively) compared with those without a history of cancer (2.3% and 2.4%, P less than .001 for all).

The elevated annual increase in rates of obesity was even higher in colorectal (3.1% in women and 3.7% in men) and breast (3.0%) cancer survivors compared with adults without a history of cancer, but was lower in prostate cancer survivors (2.1%; P = .001 for all).

“These findings call for public health planning of effective and scalable weight management and control programs for cancer survivors, especially for breast and colorectal cancer survivors and for non-Hispanic blacks,” the investigators concluded.

The National Cancer Institute funded the study. Dr. Greenlee and one other investigator reported serving in advisory roles for EHE International.

[email protected]

On Twitter @jessnicolecraig

Being overweight or obese was significantly associated with a greater risk of developing cardiotoxicity among breast cancer patients treated with anthracyclines and/or trastuzumab, investigators found.

Anthracyclines, a class of anticancer agents widely used to treat many cancer types, have a known association with cardiotoxicity. Furthermore, people who are overweight or obese have an increased risk for developing cardiovascular diseases. The purpose of this study was to “explore in greater depth the influence of overweight and obesity as aggravating factors in the development of cardiotoxicity” specifically among patients who received anthracycline and/or trastuzumab as part of their cancer treatment and were therefore at increased risk of experiencing cardiac-related adverse events, wrote Charles Guenancia, MD, PhD, of University Hospital, Dijon Cedex, France, and his associates (J Clin Oncol. 2016 July 25. doi: 10.1200/JCO.2016.67.4846).

These results are from a meta-analysis of 15 published prospective or retrospective cohort studies that investigated or otherwise reported data on the association between overweight and/or obesity and cardiotoxicity resulting from anthracycline and/or trastuzumab use for treating localized or metastatic breast cancer. Together, the 15 studies represented a total of 8,745 breast cancer patients.

Overall, the mean rate of cardiotoxicity was 17% (95% confidence interval, 11%-25%). Patients treated with anthracyclines only (n = 3,898) had a mean rate of cardiotoxicity of 20% (95% CI, 5%-43%) while patients treated with trastuzumab with or without anthracyclines (n = 4,847) had a lower mean rate of cardiotoxicity at 16% (95% CI, 10%-24%).Paired meta-analysis revealed that overweight, defined as a body mass index score of 25 to 29.9, was associated with increased risk of cardiotoxicity with an odds ratio of 1.15 (95% CI, 0.83-1.58). Obesity, defined as a body mass index score of 30 or greater, was associated with a greater risk of cardiotoxicity with an odds ratio of 1.47 (95% CI, 0.95-2.28).

The association between body mass index and the risk of cardiotoxicity did not differ significantly by drug regimen (anthracyclines alone or sequential anthracyclines and trastuzumab).

This study’s funding source was not listed. Dr. Guenancia and one other investigator reported serving in advisory roles and/or receiving financial compensation from various companies.

[email protected]

On Twitter @jessnicolecraig

Being overweight or obese was significantly associated with a greater risk of developing cardiotoxicity among breast cancer patients treated with anthracyclines and/or trastuzumab, investigators found.

Anthracyclines, a class of anticancer agents widely used to treat many cancer types, have a known association with cardiotoxicity. Furthermore, people who are overweight or obese have an increased risk for developing cardiovascular diseases. The purpose of this study was to “explore in greater depth the influence of overweight and obesity as aggravating factors in the development of cardiotoxicity” specifically among patients who received anthracycline and/or trastuzumab as part of their cancer treatment and were therefore at increased risk of experiencing cardiac-related adverse events, wrote Charles Guenancia, MD, PhD, of University Hospital, Dijon Cedex, France, and his associates (J Clin Oncol. 2016 July 25. doi: 10.1200/JCO.2016.67.4846).

These results are from a meta-analysis of 15 published prospective or retrospective cohort studies that investigated or otherwise reported data on the association between overweight and/or obesity and cardiotoxicity resulting from anthracycline and/or trastuzumab use for treating localized or metastatic breast cancer. Together, the 15 studies represented a total of 8,745 breast cancer patients.

Overall, the mean rate of cardiotoxicity was 17% (95% confidence interval, 11%-25%). Patients treated with anthracyclines only (n = 3,898) had a mean rate of cardiotoxicity of 20% (95% CI, 5%-43%) while patients treated with trastuzumab with or without anthracyclines (n = 4,847) had a lower mean rate of cardiotoxicity at 16% (95% CI, 10%-24%).Paired meta-analysis revealed that overweight, defined as a body mass index score of 25 to 29.9, was associated with increased risk of cardiotoxicity with an odds ratio of 1.15 (95% CI, 0.83-1.58). Obesity, defined as a body mass index score of 30 or greater, was associated with a greater risk of cardiotoxicity with an odds ratio of 1.47 (95% CI, 0.95-2.28).

The association between body mass index and the risk of cardiotoxicity did not differ significantly by drug regimen (anthracyclines alone or sequential anthracyclines and trastuzumab).

This study’s funding source was not listed. Dr. Guenancia and one other investigator reported serving in advisory roles and/or receiving financial compensation from various companies.

[email protected]

On Twitter @jessnicolecraig

Being overweight or obese was significantly associated with a greater risk of developing cardiotoxicity among breast cancer patients treated with anthracyclines and/or trastuzumab, investigators found.

Anthracyclines, a class of anticancer agents widely used to treat many cancer types, have a known association with cardiotoxicity. Furthermore, people who are overweight or obese have an increased risk for developing cardiovascular diseases. The purpose of this study was to “explore in greater depth the influence of overweight and obesity as aggravating factors in the development of cardiotoxicity” specifically among patients who received anthracycline and/or trastuzumab as part of their cancer treatment and were therefore at increased risk of experiencing cardiac-related adverse events, wrote Charles Guenancia, MD, PhD, of University Hospital, Dijon Cedex, France, and his associates (J Clin Oncol. 2016 July 25. doi: 10.1200/JCO.2016.67.4846).

These results are from a meta-analysis of 15 published prospective or retrospective cohort studies that investigated or otherwise reported data on the association between overweight and/or obesity and cardiotoxicity resulting from anthracycline and/or trastuzumab use for treating localized or metastatic breast cancer. Together, the 15 studies represented a total of 8,745 breast cancer patients.

Overall, the mean rate of cardiotoxicity was 17% (95% confidence interval, 11%-25%). Patients treated with anthracyclines only (n = 3,898) had a mean rate of cardiotoxicity of 20% (95% CI, 5%-43%) while patients treated with trastuzumab with or without anthracyclines (n = 4,847) had a lower mean rate of cardiotoxicity at 16% (95% CI, 10%-24%).Paired meta-analysis revealed that overweight, defined as a body mass index score of 25 to 29.9, was associated with increased risk of cardiotoxicity with an odds ratio of 1.15 (95% CI, 0.83-1.58). Obesity, defined as a body mass index score of 30 or greater, was associated with a greater risk of cardiotoxicity with an odds ratio of 1.47 (95% CI, 0.95-2.28).

The association between body mass index and the risk of cardiotoxicity did not differ significantly by drug regimen (anthracyclines alone or sequential anthracyclines and trastuzumab).

This study’s funding source was not listed. Dr. Guenancia and one other investigator reported serving in advisory roles and/or receiving financial compensation from various companies.

[email protected]

On Twitter @jessnicolecraig

All adult cancer survivors should be screened for chronic pain at every visit, according to the American Society of Clinical Oncology’s first clinical practice guideline for managing this patient population, published July 25 in the Journal of Clinical Oncology.

An estimated 14 million adults with a history of cancer are living in the United States alone, and the prevalence of chronic pain related to their malignancy is reported to be as high as 40%. Yet most health care providers “haven’t been trained to recognize or treat long-term pain associated with cancer,” Judith A. Paice, PhD, RN, said in a press statement accompanying the release of the new guideline.

Existing guidelines focus on the acute pain of cancer and its treatment, or on acute pain related to advanced cancer, said Dr. Paice, cochair of the expert panel that developed the guideline and research professor of hematology/oncology at Northwestern University, Chicago.

©Thinkstock.com

The chronic pain addressed in the new guideline document can be related to the malignancy itself or to its treatment. Surgery, chemotherapy, hormone therapy, radiation treatment, and stem-cell transplantation can induce dozens of pain-producing complications, including osteonecrosis, bone fractures, peripheral or central nerve damage, fistulas, lymphedema, arthralgias, and myelopathy. The pain can develop months or years after diagnosis, significantly impacting patients’ quality of life well after treatment is completed.

“This guideline will help clinicians identify pain early and develop comprehensive treatment plans using a broad range of approaches,” Dr. Paice said in the statement.

The panel that developed the guideline comprised experts in medical oncology, hematology, pain medicine, palliative care, hospice, radiation oncology, social work, rehabilitation, psychology, and anesthesiology. They performed a systematic review of the literature and based their recommendations on 35 meta-analyses, 9 randomized controlled trials, 19 comparative studies, and expert consensus.

Some key recommendations include the following:

• Screen all survivors of adult cancers for chronic pain using both a physical exam and an in-depth interview that covers physical, functional, psychological, social, and spiritual aspects of pain, as well as the patient’s treatment history and comorbid conditions. The guideline includes a list of 36 common pain syndromes resulting from cancer treatments.

• Monitor patients at every visit for late-onset treatment effects that can produce pain, just as they are monitored for recurrent disease and secondary malignancy. Some cancer survivors may not recognize that their current pain is related to past disease or its treatments, or may consider it an untreatable complication that they have to endure.

• Consider the entire range of pain medicines – not just opioid analgesics – including NSAIDs, acetaminophen, and selected antidepressants and anticonvulsants with analgesic efficacy. The panel noted that some cancer survivors with chronic pain may benefit from other drugs, including muscle relaxants, benzodiazepines, N-methyl-D-aspartate receptor blockers, alpha-2 agonists, and neutraceuticals and botanicals. But they urged caution since the efficacy of these agents has not been fully established.

Consider nonmedical treatments such as physical, occupational, and recreation therapy; exercise; orthotics; ultrasound; massage; acupuncture; cognitive behavioral therapy; relaxation therapy; and TENS or other types of nerve stimulation.

Consider medical cannabis or cannabinoids as an adjuvant but not a first-line pain treatment, being sure to follow specific state regulations.

Consider a trial of opioids only for carefully selected patients who don’t respond to more conservative management. Weigh potential risks against benefits and employ universal precautions to minimize abuse and addiction, and be cautious in coprescribing other centrally-acting agents (J Clin Oncol. 2016 July 25. doi: 10.1200/JCO.2016.68.5206).

The full clinical practice guideline and other clinical tools and resources are available at www.asco.org/chronic-pai-guideline.

The guideline development process was supported by ASCO. Dr. Paice reported having no relevant financial disclosures; some of her associates reported financial ties to industry sources.

All adult cancer survivors should be screened for chronic pain at every visit, according to the American Society of Clinical Oncology’s first clinical practice guideline for managing this patient population, published July 25 in the Journal of Clinical Oncology.

An estimated 14 million adults with a history of cancer are living in the United States alone, and the prevalence of chronic pain related to their malignancy is reported to be as high as 40%. Yet most health care providers “haven’t been trained to recognize or treat long-term pain associated with cancer,” Judith A. Paice, PhD, RN, said in a press statement accompanying the release of the new guideline.

Existing guidelines focus on the acute pain of cancer and its treatment, or on acute pain related to advanced cancer, said Dr. Paice, cochair of the expert panel that developed the guideline and research professor of hematology/oncology at Northwestern University, Chicago.

©Thinkstock.com

The chronic pain addressed in the new guideline document can be related to the malignancy itself or to its treatment. Surgery, chemotherapy, hormone therapy, radiation treatment, and stem-cell transplantation can induce dozens of pain-producing complications, including osteonecrosis, bone fractures, peripheral or central nerve damage, fistulas, lymphedema, arthralgias, and myelopathy. The pain can develop months or years after diagnosis, significantly impacting patients’ quality of life well after treatment is completed.

“This guideline will help clinicians identify pain early and develop comprehensive treatment plans using a broad range of approaches,” Dr. Paice said in the statement.

The panel that developed the guideline comprised experts in medical oncology, hematology, pain medicine, palliative care, hospice, radiation oncology, social work, rehabilitation, psychology, and anesthesiology. They performed a systematic review of the literature and based their recommendations on 35 meta-analyses, 9 randomized controlled trials, 19 comparative studies, and expert consensus.

Some key recommendations include the following:

• Screen all survivors of adult cancers for chronic pain using both a physical exam and an in-depth interview that covers physical, functional, psychological, social, and spiritual aspects of pain, as well as the patient’s treatment history and comorbid conditions. The guideline includes a list of 36 common pain syndromes resulting from cancer treatments.

• Monitor patients at every visit for late-onset treatment effects that can produce pain, just as they are monitored for recurrent disease and secondary malignancy. Some cancer survivors may not recognize that their current pain is related to past disease or its treatments, or may consider it an untreatable complication that they have to endure.

• Consider the entire range of pain medicines – not just opioid analgesics – including NSAIDs, acetaminophen, and selected antidepressants and anticonvulsants with analgesic efficacy. The panel noted that some cancer survivors with chronic pain may benefit from other drugs, including muscle relaxants, benzodiazepines, N-methyl-D-aspartate receptor blockers, alpha-2 agonists, and neutraceuticals and botanicals. But they urged caution since the efficacy of these agents has not been fully established.

Consider nonmedical treatments such as physical, occupational, and recreation therapy; exercise; orthotics; ultrasound; massage; acupuncture; cognitive behavioral therapy; relaxation therapy; and TENS or other types of nerve stimulation.

Consider medical cannabis or cannabinoids as an adjuvant but not a first-line pain treatment, being sure to follow specific state regulations.

Consider a trial of opioids only for carefully selected patients who don’t respond to more conservative management. Weigh potential risks against benefits and employ universal precautions to minimize abuse and addiction, and be cautious in coprescribing other centrally-acting agents (J Clin Oncol. 2016 July 25. doi: 10.1200/JCO.2016.68.5206).

The full clinical practice guideline and other clinical tools and resources are available at www.asco.org/chronic-pai-guideline.

The guideline development process was supported by ASCO. Dr. Paice reported having no relevant financial disclosures; some of her associates reported financial ties to industry sources.

All adult cancer survivors should be screened for chronic pain at every visit, according to the American Society of Clinical Oncology’s first clinical practice guideline for managing this patient population, published July 25 in the Journal of Clinical Oncology.

An estimated 14 million adults with a history of cancer are living in the United States alone, and the prevalence of chronic pain related to their malignancy is reported to be as high as 40%. Yet most health care providers “haven’t been trained to recognize or treat long-term pain associated with cancer,” Judith A. Paice, PhD, RN, said in a press statement accompanying the release of the new guideline.

Existing guidelines focus on the acute pain of cancer and its treatment, or on acute pain related to advanced cancer, said Dr. Paice, cochair of the expert panel that developed the guideline and research professor of hematology/oncology at Northwestern University, Chicago.

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The chronic pain addressed in the new guideline document can be related to the malignancy itself or to its treatment. Surgery, chemotherapy, hormone therapy, radiation treatment, and stem-cell transplantation can induce dozens of pain-producing complications, including osteonecrosis, bone fractures, peripheral or central nerve damage, fistulas, lymphedema, arthralgias, and myelopathy. The pain can develop months or years after diagnosis, significantly impacting patients’ quality of life well after treatment is completed.

“This guideline will help clinicians identify pain early and develop comprehensive treatment plans using a broad range of approaches,” Dr. Paice said in the statement.

The panel that developed the guideline comprised experts in medical oncology, hematology, pain medicine, palliative care, hospice, radiation oncology, social work, rehabilitation, psychology, and anesthesiology. They performed a systematic review of the literature and based their recommendations on 35 meta-analyses, 9 randomized controlled trials, 19 comparative studies, and expert consensus.

Some key recommendations include the following:

• Screen all survivors of adult cancers for chronic pain using both a physical exam and an in-depth interview that covers physical, functional, psychological, social, and spiritual aspects of pain, as well as the patient’s treatment history and comorbid conditions. The guideline includes a list of 36 common pain syndromes resulting from cancer treatments.

• Monitor patients at every visit for late-onset treatment effects that can produce pain, just as they are monitored for recurrent disease and secondary malignancy. Some cancer survivors may not recognize that their current pain is related to past disease or its treatments, or may consider it an untreatable complication that they have to endure.

• Consider the entire range of pain medicines – not just opioid analgesics – including NSAIDs, acetaminophen, and selected antidepressants and anticonvulsants with analgesic efficacy. The panel noted that some cancer survivors with chronic pain may benefit from other drugs, including muscle relaxants, benzodiazepines, N-methyl-D-aspartate receptor blockers, alpha-2 agonists, and neutraceuticals and botanicals. But they urged caution since the efficacy of these agents has not been fully established.

Consider nonmedical treatments such as physical, occupational, and recreation therapy; exercise; orthotics; ultrasound; massage; acupuncture; cognitive behavioral therapy; relaxation therapy; and TENS or other types of nerve stimulation.

Consider medical cannabis or cannabinoids as an adjuvant but not a first-line pain treatment, being sure to follow specific state regulations.

Consider a trial of opioids only for carefully selected patients who don’t respond to more conservative management. Weigh potential risks against benefits and employ universal precautions to minimize abuse and addiction, and be cautious in coprescribing other centrally-acting agents (J Clin Oncol. 2016 July 25. doi: 10.1200/JCO.2016.68.5206).

The full clinical practice guideline and other clinical tools and resources are available at www.asco.org/chronic-pai-guideline.

The guideline development process was supported by ASCO. Dr. Paice reported having no relevant financial disclosures; some of her associates reported financial ties to industry sources.

Acute lymphoblastic leukemia is a neoplastic proliferation of lymphoblasts in the bone marrow. Normal hematopoiesis is affected, and symptoms from anemia (fatigue, breathlessness), leukopenia (recurrent infections) or thrombocytopenia (easy bruising, mucosal bleeding) are typically described in ALL. Hepatosplenomegaly and B-symptoms (fever, weight loss, and night sweats) are frequently seen. Presence of lymphoblasts in the peripheral smear is indicative of ALL, and a bone marrow biopsy finding of >25% lymphoblasts is confirmatory. Absence of peripheral lymphoblasts in a patient with acute leukemia is known as aleukemic leukemia. Aleukemic leukemia is uncommon, and most cases have described skin lesions from lymphoblast infiltration (leukemia cutis) in addition to bone marrow involvement.¹ We report a case of aleukemic ALL in an adult presenting with unusual clinical features including bone pain, osteolytic lesions, hypercalcemia, and normal blood counts. To our knowledge, this is fifth such case ever reported in an adult patient.

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

Acute lymphoblastic leukemia is a neoplastic proliferation of lymphoblasts in the bone marrow. Normal hematopoiesis is affected, and symptoms from anemia (fatigue, breathlessness), leukopenia (recurrent infections) or thrombocytopenia (easy bruising, mucosal bleeding) are typically described in ALL. Hepatosplenomegaly and B-symptoms (fever, weight loss, and night sweats) are frequently seen. Presence of lymphoblasts in the peripheral smear is indicative of ALL, and a bone marrow biopsy finding of >25% lymphoblasts is confirmatory. Absence of peripheral lymphoblasts in a patient with acute leukemia is known as aleukemic leukemia. Aleukemic leukemia is uncommon, and most cases have described skin lesions from lymphoblast infiltration (leukemia cutis) in addition to bone marrow involvement.¹ We report a case of aleukemic ALL in an adult presenting with unusual clinical features including bone pain, osteolytic lesions, hypercalcemia, and normal blood counts. To our knowledge, this is fifth such case ever reported in an adult patient.

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

Acute lymphoblastic leukemia is a neoplastic proliferation of lymphoblasts in the bone marrow. Normal hematopoiesis is affected, and symptoms from anemia (fatigue, breathlessness), leukopenia (recurrent infections) or thrombocytopenia (easy bruising, mucosal bleeding) are typically described in ALL. Hepatosplenomegaly and B-symptoms (fever, weight loss, and night sweats) are frequently seen. Presence of lymphoblasts in the peripheral smear is indicative of ALL, and a bone marrow biopsy finding of >25% lymphoblasts is confirmatory. Absence of peripheral lymphoblasts in a patient with acute leukemia is known as aleukemic leukemia. Aleukemic leukemia is uncommon, and most cases have described skin lesions from lymphoblast infiltration (leukemia cutis) in addition to bone marrow involvement.¹ We report a case of aleukemic ALL in an adult presenting with unusual clinical features including bone pain, osteolytic lesions, hypercalcemia, and normal blood counts. To our knowledge, this is fifth such case ever reported in an adult patient.

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