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The impact of loss of income and medicine costs on the financial burden for cancer patients in Australia
Background The cost of medicines may prove prohibitive for some cancer patients, potentially reducing the ability of a health system to fully deliver best practice care.
Objective To identify nonuse or nonpurchase of cancer-related medicines due to cost, and to describe the perceived financial burden of such medicines and associated patient characteristics.
Methods A cross-sectional pen-and-paper questionnaire was completed by oncology outpatients at 2 hospitals in Australia; 1 in regional New South Wales and 1 in metropolitan Victoria.
Results Almost 1 in 10 study participants had used over-the-counter medicines rather than prescribed medicines for cancer and obtained some but not all of the medicines prescribed in relation to their cancer. 63% of the sample reported some level of financial burden associated with obtaining these medicines, with 34% reporting a moderate or heavy financial burden. 11.8% reported using alternatives to prescribed medicines. People reporting reduced income after being diagnosed with cancer had almost 4 times the odds (OR, 3.73; 95% CI, 1.1-12.1) of reporting a heavy or extreme financial burden associated with prescribed medicines for cancer.
Limitations Study response rate, narrow survey population, self-reported survey used.
Conclusion This study identifies that a number of cancer patients, especially those with a reduced income after their diagnosis, experience financial burden associated with the purchase of medicines and that some go as far as to not use or to not purchase medicines. It seems likely that limiting the cost of medicines for cancer may improve patient ability to fully participate in the intended treatment.
Funding Cancer Council NSW, National Health and Medical Research Council, and Hunter Medical Research Institute, Australia
Click on the PDF icon at the top of this introduction to read the full article.
Background The cost of medicines may prove prohibitive for some cancer patients, potentially reducing the ability of a health system to fully deliver best practice care.
Objective To identify nonuse or nonpurchase of cancer-related medicines due to cost, and to describe the perceived financial burden of such medicines and associated patient characteristics.
Methods A cross-sectional pen-and-paper questionnaire was completed by oncology outpatients at 2 hospitals in Australia; 1 in regional New South Wales and 1 in metropolitan Victoria.
Results Almost 1 in 10 study participants had used over-the-counter medicines rather than prescribed medicines for cancer and obtained some but not all of the medicines prescribed in relation to their cancer. 63% of the sample reported some level of financial burden associated with obtaining these medicines, with 34% reporting a moderate or heavy financial burden. 11.8% reported using alternatives to prescribed medicines. People reporting reduced income after being diagnosed with cancer had almost 4 times the odds (OR, 3.73; 95% CI, 1.1-12.1) of reporting a heavy or extreme financial burden associated with prescribed medicines for cancer.
Limitations Study response rate, narrow survey population, self-reported survey used.
Conclusion This study identifies that a number of cancer patients, especially those with a reduced income after their diagnosis, experience financial burden associated with the purchase of medicines and that some go as far as to not use or to not purchase medicines. It seems likely that limiting the cost of medicines for cancer may improve patient ability to fully participate in the intended treatment.
Funding Cancer Council NSW, National Health and Medical Research Council, and Hunter Medical Research Institute, Australia
Click on the PDF icon at the top of this introduction to read the full article.
Background The cost of medicines may prove prohibitive for some cancer patients, potentially reducing the ability of a health system to fully deliver best practice care.
Objective To identify nonuse or nonpurchase of cancer-related medicines due to cost, and to describe the perceived financial burden of such medicines and associated patient characteristics.
Methods A cross-sectional pen-and-paper questionnaire was completed by oncology outpatients at 2 hospitals in Australia; 1 in regional New South Wales and 1 in metropolitan Victoria.
Results Almost 1 in 10 study participants had used over-the-counter medicines rather than prescribed medicines for cancer and obtained some but not all of the medicines prescribed in relation to their cancer. 63% of the sample reported some level of financial burden associated with obtaining these medicines, with 34% reporting a moderate or heavy financial burden. 11.8% reported using alternatives to prescribed medicines. People reporting reduced income after being diagnosed with cancer had almost 4 times the odds (OR, 3.73; 95% CI, 1.1-12.1) of reporting a heavy or extreme financial burden associated with prescribed medicines for cancer.
Limitations Study response rate, narrow survey population, self-reported survey used.
Conclusion This study identifies that a number of cancer patients, especially those with a reduced income after their diagnosis, experience financial burden associated with the purchase of medicines and that some go as far as to not use or to not purchase medicines. It seems likely that limiting the cost of medicines for cancer may improve patient ability to fully participate in the intended treatment.
Funding Cancer Council NSW, National Health and Medical Research Council, and Hunter Medical Research Institute, Australia
Click on the PDF icon at the top of this introduction to read the full article.
Adolescent and young adult perceptions of cancer survivor care and supportive programming
Background Improvements in cancer therapy have led to an increasing number of adolescent and young adult (AYA) survivors of childhood cancers. Many survivors have ongoing needs for support and information that are not being met.
Objective To conduct a program evaluation to identify AYAs’ perceptions of survivor care services.
Methods Using a community-based approach, 157 AYA childhood cancer survivors (aged 15-30 years) completed a program evaluation survey to assess perceptions of the importance of survivor patient care services and supportive programming using a Likert scale (1, Not At All Important; 2, Of Little Importance; 3, Somewhat Important; 4, Important; 5, Very Important).
Results Receipt of a medical summary was ranked as the most important survivor patient care service (mean, 4.5; SD, 0.91). 70% of respondents reported interest in late-effects education. Informational mailings were the most valued form of supportive programming and were endorsed by 62% of AYAs. Older survivors were more likely to value workshops (P = .01-0.05), whereas those aged 19-22 years valued weekend retreats (P < .01) and social activities (P < .01). Survivors of brain/CNS tumors were more likely to value social activities (P = .03) and support groups (P = .03), compared with leukemia survivors.
Limitations Contact information from the hospital tumor registry was used, which limited the number of correct addresses.
Conclusion The greatest care needs reported by AYA survivors of childhood cancer are services such as generation of a medical summary, late-effects education, and survivor-focused follow-up care, which are provided through cancer survivor programs. Development of additional programming to engage and further educate and encourage AYA survivors will be important to reinforce their adherence with survivor care throughout adulthood.
Funding/Sponsorship LiveStrong Community Based Participatory Research Planning Grant
Click on the PDF icon at the top of this introduction to read the full article.
Background Improvements in cancer therapy have led to an increasing number of adolescent and young adult (AYA) survivors of childhood cancers. Many survivors have ongoing needs for support and information that are not being met.
Objective To conduct a program evaluation to identify AYAs’ perceptions of survivor care services.
Methods Using a community-based approach, 157 AYA childhood cancer survivors (aged 15-30 years) completed a program evaluation survey to assess perceptions of the importance of survivor patient care services and supportive programming using a Likert scale (1, Not At All Important; 2, Of Little Importance; 3, Somewhat Important; 4, Important; 5, Very Important).
Results Receipt of a medical summary was ranked as the most important survivor patient care service (mean, 4.5; SD, 0.91). 70% of respondents reported interest in late-effects education. Informational mailings were the most valued form of supportive programming and were endorsed by 62% of AYAs. Older survivors were more likely to value workshops (P = .01-0.05), whereas those aged 19-22 years valued weekend retreats (P < .01) and social activities (P < .01). Survivors of brain/CNS tumors were more likely to value social activities (P = .03) and support groups (P = .03), compared with leukemia survivors.
Limitations Contact information from the hospital tumor registry was used, which limited the number of correct addresses.
Conclusion The greatest care needs reported by AYA survivors of childhood cancer are services such as generation of a medical summary, late-effects education, and survivor-focused follow-up care, which are provided through cancer survivor programs. Development of additional programming to engage and further educate and encourage AYA survivors will be important to reinforce their adherence with survivor care throughout adulthood.
Funding/Sponsorship LiveStrong Community Based Participatory Research Planning Grant
Click on the PDF icon at the top of this introduction to read the full article.
Background Improvements in cancer therapy have led to an increasing number of adolescent and young adult (AYA) survivors of childhood cancers. Many survivors have ongoing needs for support and information that are not being met.
Objective To conduct a program evaluation to identify AYAs’ perceptions of survivor care services.
Methods Using a community-based approach, 157 AYA childhood cancer survivors (aged 15-30 years) completed a program evaluation survey to assess perceptions of the importance of survivor patient care services and supportive programming using a Likert scale (1, Not At All Important; 2, Of Little Importance; 3, Somewhat Important; 4, Important; 5, Very Important).
Results Receipt of a medical summary was ranked as the most important survivor patient care service (mean, 4.5; SD, 0.91). 70% of respondents reported interest in late-effects education. Informational mailings were the most valued form of supportive programming and were endorsed by 62% of AYAs. Older survivors were more likely to value workshops (P = .01-0.05), whereas those aged 19-22 years valued weekend retreats (P < .01) and social activities (P < .01). Survivors of brain/CNS tumors were more likely to value social activities (P = .03) and support groups (P = .03), compared with leukemia survivors.
Limitations Contact information from the hospital tumor registry was used, which limited the number of correct addresses.
Conclusion The greatest care needs reported by AYA survivors of childhood cancer are services such as generation of a medical summary, late-effects education, and survivor-focused follow-up care, which are provided through cancer survivor programs. Development of additional programming to engage and further educate and encourage AYA survivors will be important to reinforce their adherence with survivor care throughout adulthood.
Funding/Sponsorship LiveStrong Community Based Participatory Research Planning Grant
Click on the PDF icon at the top of this introduction to read the full article.
Symptoms, unmet need, and quality of life among recent breast cancer survivors
Background Assessing patient quality of life (QoL) apart from symptoms and unmet need may miss important concerns for which remediation is possible. Therapeutic advances have improved survival among breast cancer patients, and 89% can expect to survive for longer than 5 years. However, the price is lasting physical and psychosocial symptoms. Education regarding the value of symptom reduction may be needed for breast cancer survivors and their providers.
Objective To examine the unmet needs for symptom management and the relationships between unmet needs, symptom burden, and patient QoL.
Method Eligibility included nonmetastatic breast cancer survivors who had been treated less than a year before the study and attendance at a survivorship appointment. QoL was assessed using the Medical Outcomes Study Short Form-12 (scale, 0 [Did Not Experience] to 5 [As Bad As Possible]), and 19 symptoms were evaluated. Participants reported unmet need for assistance for each symptom experienced.
Results 164 primarily white, middle-aged, early-stage survivors of breast cancer were recruited. Physical and Mental QoL were similar to national norms. Survivors reported an average of 11.5 symptoms, most commonly Fatigue, Insomnia, Hot Flashes, Joint Pain, but reported unmet need for fewer symptoms (mean, 2.6). Weight Gain, Joint Pain, Numbness were most likely to result in unmet need. Both Physical and Mental QoL were negatively associated with number of symptoms (r = -.46 and -.41, respectively) and unmet needs (r = -.17 and -.41, respectively).
Limitations Cross-sectional sample of consecutive patients from a single clinical site.
Conclusion Symptoms are common among recent survivors of breast cancer, as are unmet needs, but to a lesser extent. Both have a negative impact on Physical and Mental health QoL.
Funding Translational Center of Excellence in Breast Cancer at the Abramson Cancer Center, University of Pennsylvania
Click on the PDF icon at the top of this introduction to read the full article.
Background Assessing patient quality of life (QoL) apart from symptoms and unmet need may miss important concerns for which remediation is possible. Therapeutic advances have improved survival among breast cancer patients, and 89% can expect to survive for longer than 5 years. However, the price is lasting physical and psychosocial symptoms. Education regarding the value of symptom reduction may be needed for breast cancer survivors and their providers.
Objective To examine the unmet needs for symptom management and the relationships between unmet needs, symptom burden, and patient QoL.
Method Eligibility included nonmetastatic breast cancer survivors who had been treated less than a year before the study and attendance at a survivorship appointment. QoL was assessed using the Medical Outcomes Study Short Form-12 (scale, 0 [Did Not Experience] to 5 [As Bad As Possible]), and 19 symptoms were evaluated. Participants reported unmet need for assistance for each symptom experienced.
Results 164 primarily white, middle-aged, early-stage survivors of breast cancer were recruited. Physical and Mental QoL were similar to national norms. Survivors reported an average of 11.5 symptoms, most commonly Fatigue, Insomnia, Hot Flashes, Joint Pain, but reported unmet need for fewer symptoms (mean, 2.6). Weight Gain, Joint Pain, Numbness were most likely to result in unmet need. Both Physical and Mental QoL were negatively associated with number of symptoms (r = -.46 and -.41, respectively) and unmet needs (r = -.17 and -.41, respectively).
Limitations Cross-sectional sample of consecutive patients from a single clinical site.
Conclusion Symptoms are common among recent survivors of breast cancer, as are unmet needs, but to a lesser extent. Both have a negative impact on Physical and Mental health QoL.
Funding Translational Center of Excellence in Breast Cancer at the Abramson Cancer Center, University of Pennsylvania
Click on the PDF icon at the top of this introduction to read the full article.
Background Assessing patient quality of life (QoL) apart from symptoms and unmet need may miss important concerns for which remediation is possible. Therapeutic advances have improved survival among breast cancer patients, and 89% can expect to survive for longer than 5 years. However, the price is lasting physical and psychosocial symptoms. Education regarding the value of symptom reduction may be needed for breast cancer survivors and their providers.
Objective To examine the unmet needs for symptom management and the relationships between unmet needs, symptom burden, and patient QoL.
Method Eligibility included nonmetastatic breast cancer survivors who had been treated less than a year before the study and attendance at a survivorship appointment. QoL was assessed using the Medical Outcomes Study Short Form-12 (scale, 0 [Did Not Experience] to 5 [As Bad As Possible]), and 19 symptoms were evaluated. Participants reported unmet need for assistance for each symptom experienced.
Results 164 primarily white, middle-aged, early-stage survivors of breast cancer were recruited. Physical and Mental QoL were similar to national norms. Survivors reported an average of 11.5 symptoms, most commonly Fatigue, Insomnia, Hot Flashes, Joint Pain, but reported unmet need for fewer symptoms (mean, 2.6). Weight Gain, Joint Pain, Numbness were most likely to result in unmet need. Both Physical and Mental QoL were negatively associated with number of symptoms (r = -.46 and -.41, respectively) and unmet needs (r = -.17 and -.41, respectively).
Limitations Cross-sectional sample of consecutive patients from a single clinical site.
Conclusion Symptoms are common among recent survivors of breast cancer, as are unmet needs, but to a lesser extent. Both have a negative impact on Physical and Mental health QoL.
Funding Translational Center of Excellence in Breast Cancer at the Abramson Cancer Center, University of Pennsylvania
Click on the PDF icon at the top of this introduction to read the full article.
Multivisceral resection for growing teratoma syndrome: overcoming pessimism
Growing teratoma syndrome (GTS) is a rare condition seen in patients with germ-cell tumors (GCT) who present with enlarging masses during or after appropriate chemotherapy with normalized serum markers.1 Three defining criteria for GTS are: a persistently growing tumor mass or evolving new mass during or after chemotherapy, normalization of tumor markers, and presence of only mature teratoma in the resected specimen on the final histopathological examination.1 Growing teratomas lack the metastatic potential; however, their relentless local growth causes compression and infiltration of adjacent organs, which produces symptoms.
Click on the PDF icon at the top of this introduction to read the full article.
Growing teratoma syndrome (GTS) is a rare condition seen in patients with germ-cell tumors (GCT) who present with enlarging masses during or after appropriate chemotherapy with normalized serum markers.1 Three defining criteria for GTS are: a persistently growing tumor mass or evolving new mass during or after chemotherapy, normalization of tumor markers, and presence of only mature teratoma in the resected specimen on the final histopathological examination.1 Growing teratomas lack the metastatic potential; however, their relentless local growth causes compression and infiltration of adjacent organs, which produces symptoms.
Click on the PDF icon at the top of this introduction to read the full article.
Growing teratoma syndrome (GTS) is a rare condition seen in patients with germ-cell tumors (GCT) who present with enlarging masses during or after appropriate chemotherapy with normalized serum markers.1 Three defining criteria for GTS are: a persistently growing tumor mass or evolving new mass during or after chemotherapy, normalization of tumor markers, and presence of only mature teratoma in the resected specimen on the final histopathological examination.1 Growing teratomas lack the metastatic potential; however, their relentless local growth causes compression and infiltration of adjacent organs, which produces symptoms.
Click on the PDF icon at the top of this introduction to read the full article.
Pathways, processes, team work: paving the way for value-based care with the quadruple aim
While we can imagine what a high-quality, state-of- the-art cancer care system might deliver in terms of value-based care and how it might yield exceptional patient outcomes and job satisfaction for our staff, most of us are struggling with the processes and tools needed to achieve defined outcomes that can be benchmarked and further refined – all within the limits of our already hectic 12-, 14,- 16+-hour days. As more community practices, academic centers, and hospitals align to share and leverage expertise in their efforts to form more streamlined, patient-centered delivery systems for cancer care, we need to set up, refine, and integrate pathways into pathway programs that will pave the way to the delivery of value-based care.
Click on the PDF icon at the top of this introduction to read the full article.
While we can imagine what a high-quality, state-of- the-art cancer care system might deliver in terms of value-based care and how it might yield exceptional patient outcomes and job satisfaction for our staff, most of us are struggling with the processes and tools needed to achieve defined outcomes that can be benchmarked and further refined – all within the limits of our already hectic 12-, 14,- 16+-hour days. As more community practices, academic centers, and hospitals align to share and leverage expertise in their efforts to form more streamlined, patient-centered delivery systems for cancer care, we need to set up, refine, and integrate pathways into pathway programs that will pave the way to the delivery of value-based care.
Click on the PDF icon at the top of this introduction to read the full article.
While we can imagine what a high-quality, state-of- the-art cancer care system might deliver in terms of value-based care and how it might yield exceptional patient outcomes and job satisfaction for our staff, most of us are struggling with the processes and tools needed to achieve defined outcomes that can be benchmarked and further refined – all within the limits of our already hectic 12-, 14,- 16+-hour days. As more community practices, academic centers, and hospitals align to share and leverage expertise in their efforts to form more streamlined, patient-centered delivery systems for cancer care, we need to set up, refine, and integrate pathways into pathway programs that will pave the way to the delivery of value-based care.
Click on the PDF icon at the top of this introduction to read the full article.
Disparities in prostate cancer treatment found at both academic and community centers
Academic and community cancer centers demonstrated similarly high rates of sociodemographic disparities in prostate cancer treatment patterns, a study showed.
Specifically, black, Hispanic, and uninsured patients were less likely to receive definitive therapy for high-risk prostate cancer at community and academic cancer centers than were white or privately insured patients. In addition, white patients began receiving therapy earlier than black and Hispanic patients at both community and academic medical centers.
“The finding that disparities exist across cancer care centers, regardless of academic versus community center structure, suggests that there may be something intrinsic about systemic, provider-level, or patient-level issues that may be interfering with treatment,” wrote Brandon Mahal, MD, of Brigham and Women’s Hospital in Boston and his associates (Cancer. July 2016. doi:10.1002/cncr.30205).
Dr. Mahal and associates identified 138,019 patients with high-risk prostate cancer who had a definitive treatment history available through the National Cancer Data Base. Definitive therapy was defined as either prostatectomy or radiation therapy plus androgen-deprivation therapy. High-risk disease was defined as having a prostate-specific antigen score above 20 ng/mL, a Gleason score of 8-10, or a clinical tumor classification of cT3a.
The investigators found black, Hispanic, and uninsured patients were less likely to receive definitive therapy at community cancer centers than were white or privately insured patients (adjusted odds ratios: 0.60, 0.69, and 0.25; 95% confidence intervals: 0.56-0.64, 0.61-0.78, and 0.22-0.30 for black, Hispanic, and uninsured patients; P less than .001). This finding was also true for patients who received treatment at academic cancer centers (AOR: 0.50, 0.56, and 0.31; 95% CI: 0.46-0.54, 0.50-0.64, and 0.28-0.36; P less than .001 for all).
At academic centers, the median time until receipt of definitive treatment was 83 days for white patients, 102 days for black patients, and 94 days for Hispanic patients. At community centers, the median time until receipt of treatment was 77 days for white patients, 92 days for black patients, and 87 days for Hispanic patients.
This study was supported by David and Cynthia Chapin, Hugh Simons, the Campbell Family, the Prostate Cancer Foundation, Fitz’s Cancer Warriors, the Scott Forbes and Gina Ventre Fund, and a grant from an anonymous foundation. Three investigators reported receiving financial compensation from multiple companies.
On Twitter @jessnicolecraig
Academic and community cancer centers demonstrated similarly high rates of sociodemographic disparities in prostate cancer treatment patterns, a study showed.
Specifically, black, Hispanic, and uninsured patients were less likely to receive definitive therapy for high-risk prostate cancer at community and academic cancer centers than were white or privately insured patients. In addition, white patients began receiving therapy earlier than black and Hispanic patients at both community and academic medical centers.
“The finding that disparities exist across cancer care centers, regardless of academic versus community center structure, suggests that there may be something intrinsic about systemic, provider-level, or patient-level issues that may be interfering with treatment,” wrote Brandon Mahal, MD, of Brigham and Women’s Hospital in Boston and his associates (Cancer. July 2016. doi:10.1002/cncr.30205).
Dr. Mahal and associates identified 138,019 patients with high-risk prostate cancer who had a definitive treatment history available through the National Cancer Data Base. Definitive therapy was defined as either prostatectomy or radiation therapy plus androgen-deprivation therapy. High-risk disease was defined as having a prostate-specific antigen score above 20 ng/mL, a Gleason score of 8-10, or a clinical tumor classification of cT3a.
The investigators found black, Hispanic, and uninsured patients were less likely to receive definitive therapy at community cancer centers than were white or privately insured patients (adjusted odds ratios: 0.60, 0.69, and 0.25; 95% confidence intervals: 0.56-0.64, 0.61-0.78, and 0.22-0.30 for black, Hispanic, and uninsured patients; P less than .001). This finding was also true for patients who received treatment at academic cancer centers (AOR: 0.50, 0.56, and 0.31; 95% CI: 0.46-0.54, 0.50-0.64, and 0.28-0.36; P less than .001 for all).
At academic centers, the median time until receipt of definitive treatment was 83 days for white patients, 102 days for black patients, and 94 days for Hispanic patients. At community centers, the median time until receipt of treatment was 77 days for white patients, 92 days for black patients, and 87 days for Hispanic patients.
This study was supported by David and Cynthia Chapin, Hugh Simons, the Campbell Family, the Prostate Cancer Foundation, Fitz’s Cancer Warriors, the Scott Forbes and Gina Ventre Fund, and a grant from an anonymous foundation. Three investigators reported receiving financial compensation from multiple companies.
On Twitter @jessnicolecraig
Academic and community cancer centers demonstrated similarly high rates of sociodemographic disparities in prostate cancer treatment patterns, a study showed.
Specifically, black, Hispanic, and uninsured patients were less likely to receive definitive therapy for high-risk prostate cancer at community and academic cancer centers than were white or privately insured patients. In addition, white patients began receiving therapy earlier than black and Hispanic patients at both community and academic medical centers.
“The finding that disparities exist across cancer care centers, regardless of academic versus community center structure, suggests that there may be something intrinsic about systemic, provider-level, or patient-level issues that may be interfering with treatment,” wrote Brandon Mahal, MD, of Brigham and Women’s Hospital in Boston and his associates (Cancer. July 2016. doi:10.1002/cncr.30205).
Dr. Mahal and associates identified 138,019 patients with high-risk prostate cancer who had a definitive treatment history available through the National Cancer Data Base. Definitive therapy was defined as either prostatectomy or radiation therapy plus androgen-deprivation therapy. High-risk disease was defined as having a prostate-specific antigen score above 20 ng/mL, a Gleason score of 8-10, or a clinical tumor classification of cT3a.
The investigators found black, Hispanic, and uninsured patients were less likely to receive definitive therapy at community cancer centers than were white or privately insured patients (adjusted odds ratios: 0.60, 0.69, and 0.25; 95% confidence intervals: 0.56-0.64, 0.61-0.78, and 0.22-0.30 for black, Hispanic, and uninsured patients; P less than .001). This finding was also true for patients who received treatment at academic cancer centers (AOR: 0.50, 0.56, and 0.31; 95% CI: 0.46-0.54, 0.50-0.64, and 0.28-0.36; P less than .001 for all).
At academic centers, the median time until receipt of definitive treatment was 83 days for white patients, 102 days for black patients, and 94 days for Hispanic patients. At community centers, the median time until receipt of treatment was 77 days for white patients, 92 days for black patients, and 87 days for Hispanic patients.
This study was supported by David and Cynthia Chapin, Hugh Simons, the Campbell Family, the Prostate Cancer Foundation, Fitz’s Cancer Warriors, the Scott Forbes and Gina Ventre Fund, and a grant from an anonymous foundation. Three investigators reported receiving financial compensation from multiple companies.
On Twitter @jessnicolecraig
FROM CANCER
Key clinical point: Academic and community cancer centers demonstrated similarly high rates of sociodemographic disparities in prostate cancer treatment patterns.
Major finding: Black, Hispanic, and uninsured patients were less likely to receive definitive therapy at community cancer centers than were white or privately insured patients (adjusted odds ratios: 0.60, 0.69, and 0.25; 95% confidence intervals: 0.56-0.64, 0.61-0.78, and 0.22-0.30 for black, Hispanic, and uninsured patients; P less than .001), and were less likely to receive definitive therapy at academic cancer centers (AOR: 0.50, 0.56, and 0.31; 95% CI: 0.46-0.54, 0.50-0.64, 0.28-0.36; P less than .001 for all).
Data source: A retrospective analysis of 138,019 patients with high-risk prostate cancer who had a definitive treatment history available in the National Cancer Data Base.
Disclosures: This study was supported by David and Cynthia Chapin, Hugh Simons, the Campbell Family, the Prostate Cancer Foundation, Fitz’s Cancer Warriors, the Scott Forbes and Gina Ventre Fund, and a grant from an anonymous foundation. Three investigators reported receiving financial compensation from multiple companies.
New IDSA aspergillosis guidelines endorse galactomannan for diagnosis
New aspergillosis guidelines from the Infectious Diseases Society of America recommend serum and bronchoalveolar lavage galactomannan as a marker for the diagnosis of invasive Aspergillus in adult and pediatric patients who have hematologic malignancies or have undergone hematopoietic stem cell transplants.
Serial monitoring of serum galactomannan (GM) is also useful to monitor disease progression, therapeutic response, and prognosis in hematologic malignancy and hematopoietic stem cell transplant (HSCT) patients who have elevated baseline GM (Clin Infect Dis. 2016 Jun 29. doi: 10.1093/cid/ciw326).
Serum beta-D-glucan assays also are recommended for diagnosing invasive Aspergillus (IA) in high-risk hematologic malignancy and allogeneic HSCT patients, although these tests are not very specific for the infection.
The advice illustrates the Society’s emphasis on early diagnosis in its new guidelines, which supplant the group’s 2008 guidance. There are almost 100 recommendations covering – in depth – the management of invasive, allergic, and chronic Aspergillus infections in all their manifestations. It’s a step-by-step, how-to manual for handling the problem.
“Aspergillosis mortality rates have decreased significantly in recent years, but there is still significant mortality from the infection, and we have a ways to go. We felt that early diagnosis was key, which is why it’s such an important part of these guidelines,” said lead author Thomas Patterson, MD, chief of the Division of Infectious Diseases at the University of Texas Health Science Center, San Antonio. He highlighted the most important developments in a recent interview.
“We know a lot more since 2008 about the benefits of using biomarkers like GM in bronchoalveolar lavage samples, which could be highly useful for diagnosis. However, biomarkers have not been as well validated for biologic response and are not recommended” in most cases for monitoring how well patients are doing. Also, “biomarkers are not as useful in solid organ transplants; we discuss that” in the guidelines, Dr. Patterson said.
The society came out against routine polymerase chain reaction (PCR) testing of blood samples for diagnosis. Although there has been a lot of work on the technique, the evidence isn’t strong enough yet to establish overall clinical benefit, but there is emerging evidence for the diagnostic use of PCR in conjunction with radiologic findings.
For treatment, voriconazole remains the go-to drug, but the guidelines make room for more recently approved therapies. “We now have isavuconazole, which may be better tolerated,” but it’s recommended only as an alternative to voriconazole because evidence comes mostly from a single clinical trial, he said.
Posaconazole extended-release tablets are strongly recommended as prophylaxis based on high-quality evidence from studies in neutropenic patients. Posaconazole extended-release tablets result in significantly higher antifungal blood levels than those seen with voriconazole, and “it certainly has been useful in some patients”; however, posaconazole is not approved for primary therapy in the United States, Dr. Patterson said.
A large clinical trial that tested voriconazole plus an echinocandin against voriconazole alone found that in patients diagnosed using serum galactomannan – especially those with hematologic malignancies – outcomes were better with the combination. “The panel felt combinations could be considered in some patients” but didn’t recommend them for routine use because [again,] there’s not strong evidence,” he said.
For now, it seems that higher-risk patients with hematologic malignancies and those with more widespread disease might be the ones who benefit most from combination therapy.
“We also discussed allergic and saprophytic diseases. We know that some patients with allergic bronchopulmonary aspergillosis will respond to antifungal therapy, and perhaps reduce their need for steroids, so that’s now part of the suggestions, as well,” he said.
The IDSA funded the work. Dr. Patterson receives research funding from Astellas, Merck, and Revolution Medicines, and has been an adviser to numerous drug companies.
New aspergillosis guidelines from the Infectious Diseases Society of America recommend serum and bronchoalveolar lavage galactomannan as a marker for the diagnosis of invasive Aspergillus in adult and pediatric patients who have hematologic malignancies or have undergone hematopoietic stem cell transplants.
Serial monitoring of serum galactomannan (GM) is also useful to monitor disease progression, therapeutic response, and prognosis in hematologic malignancy and hematopoietic stem cell transplant (HSCT) patients who have elevated baseline GM (Clin Infect Dis. 2016 Jun 29. doi: 10.1093/cid/ciw326).
Serum beta-D-glucan assays also are recommended for diagnosing invasive Aspergillus (IA) in high-risk hematologic malignancy and allogeneic HSCT patients, although these tests are not very specific for the infection.
The advice illustrates the Society’s emphasis on early diagnosis in its new guidelines, which supplant the group’s 2008 guidance. There are almost 100 recommendations covering – in depth – the management of invasive, allergic, and chronic Aspergillus infections in all their manifestations. It’s a step-by-step, how-to manual for handling the problem.
“Aspergillosis mortality rates have decreased significantly in recent years, but there is still significant mortality from the infection, and we have a ways to go. We felt that early diagnosis was key, which is why it’s such an important part of these guidelines,” said lead author Thomas Patterson, MD, chief of the Division of Infectious Diseases at the University of Texas Health Science Center, San Antonio. He highlighted the most important developments in a recent interview.
“We know a lot more since 2008 about the benefits of using biomarkers like GM in bronchoalveolar lavage samples, which could be highly useful for diagnosis. However, biomarkers have not been as well validated for biologic response and are not recommended” in most cases for monitoring how well patients are doing. Also, “biomarkers are not as useful in solid organ transplants; we discuss that” in the guidelines, Dr. Patterson said.
The society came out against routine polymerase chain reaction (PCR) testing of blood samples for diagnosis. Although there has been a lot of work on the technique, the evidence isn’t strong enough yet to establish overall clinical benefit, but there is emerging evidence for the diagnostic use of PCR in conjunction with radiologic findings.
For treatment, voriconazole remains the go-to drug, but the guidelines make room for more recently approved therapies. “We now have isavuconazole, which may be better tolerated,” but it’s recommended only as an alternative to voriconazole because evidence comes mostly from a single clinical trial, he said.
Posaconazole extended-release tablets are strongly recommended as prophylaxis based on high-quality evidence from studies in neutropenic patients. Posaconazole extended-release tablets result in significantly higher antifungal blood levels than those seen with voriconazole, and “it certainly has been useful in some patients”; however, posaconazole is not approved for primary therapy in the United States, Dr. Patterson said.
A large clinical trial that tested voriconazole plus an echinocandin against voriconazole alone found that in patients diagnosed using serum galactomannan – especially those with hematologic malignancies – outcomes were better with the combination. “The panel felt combinations could be considered in some patients” but didn’t recommend them for routine use because [again,] there’s not strong evidence,” he said.
For now, it seems that higher-risk patients with hematologic malignancies and those with more widespread disease might be the ones who benefit most from combination therapy.
“We also discussed allergic and saprophytic diseases. We know that some patients with allergic bronchopulmonary aspergillosis will respond to antifungal therapy, and perhaps reduce their need for steroids, so that’s now part of the suggestions, as well,” he said.
The IDSA funded the work. Dr. Patterson receives research funding from Astellas, Merck, and Revolution Medicines, and has been an adviser to numerous drug companies.
New aspergillosis guidelines from the Infectious Diseases Society of America recommend serum and bronchoalveolar lavage galactomannan as a marker for the diagnosis of invasive Aspergillus in adult and pediatric patients who have hematologic malignancies or have undergone hematopoietic stem cell transplants.
Serial monitoring of serum galactomannan (GM) is also useful to monitor disease progression, therapeutic response, and prognosis in hematologic malignancy and hematopoietic stem cell transplant (HSCT) patients who have elevated baseline GM (Clin Infect Dis. 2016 Jun 29. doi: 10.1093/cid/ciw326).
Serum beta-D-glucan assays also are recommended for diagnosing invasive Aspergillus (IA) in high-risk hematologic malignancy and allogeneic HSCT patients, although these tests are not very specific for the infection.
The advice illustrates the Society’s emphasis on early diagnosis in its new guidelines, which supplant the group’s 2008 guidance. There are almost 100 recommendations covering – in depth – the management of invasive, allergic, and chronic Aspergillus infections in all their manifestations. It’s a step-by-step, how-to manual for handling the problem.
“Aspergillosis mortality rates have decreased significantly in recent years, but there is still significant mortality from the infection, and we have a ways to go. We felt that early diagnosis was key, which is why it’s such an important part of these guidelines,” said lead author Thomas Patterson, MD, chief of the Division of Infectious Diseases at the University of Texas Health Science Center, San Antonio. He highlighted the most important developments in a recent interview.
“We know a lot more since 2008 about the benefits of using biomarkers like GM in bronchoalveolar lavage samples, which could be highly useful for diagnosis. However, biomarkers have not been as well validated for biologic response and are not recommended” in most cases for monitoring how well patients are doing. Also, “biomarkers are not as useful in solid organ transplants; we discuss that” in the guidelines, Dr. Patterson said.
The society came out against routine polymerase chain reaction (PCR) testing of blood samples for diagnosis. Although there has been a lot of work on the technique, the evidence isn’t strong enough yet to establish overall clinical benefit, but there is emerging evidence for the diagnostic use of PCR in conjunction with radiologic findings.
For treatment, voriconazole remains the go-to drug, but the guidelines make room for more recently approved therapies. “We now have isavuconazole, which may be better tolerated,” but it’s recommended only as an alternative to voriconazole because evidence comes mostly from a single clinical trial, he said.
Posaconazole extended-release tablets are strongly recommended as prophylaxis based on high-quality evidence from studies in neutropenic patients. Posaconazole extended-release tablets result in significantly higher antifungal blood levels than those seen with voriconazole, and “it certainly has been useful in some patients”; however, posaconazole is not approved for primary therapy in the United States, Dr. Patterson said.
A large clinical trial that tested voriconazole plus an echinocandin against voriconazole alone found that in patients diagnosed using serum galactomannan – especially those with hematologic malignancies – outcomes were better with the combination. “The panel felt combinations could be considered in some patients” but didn’t recommend them for routine use because [again,] there’s not strong evidence,” he said.
For now, it seems that higher-risk patients with hematologic malignancies and those with more widespread disease might be the ones who benefit most from combination therapy.
“We also discussed allergic and saprophytic diseases. We know that some patients with allergic bronchopulmonary aspergillosis will respond to antifungal therapy, and perhaps reduce their need for steroids, so that’s now part of the suggestions, as well,” he said.
The IDSA funded the work. Dr. Patterson receives research funding from Astellas, Merck, and Revolution Medicines, and has been an adviser to numerous drug companies.
FROM CLINICAL INFECTIOUS DISEASES
Olanzapine helps prevent nausea in patients on chemo
Olanzapine is more effective than placebo, in combination with a 5-HT3-receptor antagonist and an NK1-receptor antagonist, in preventing nausea in patients undergoing chemotherapy, according to investigators.
“This large, randomized, double-blind, placebo-controlled, phase III trial showed that it is more effective to combine olanzapine than placebo with an NK1-receptor antagonist, a 5-HT3–receptor antagonist, and dexamethasone for the prevention of nausea and vomiting in patients who have not received previous chemotherapy but are currently receiving highly emetogenic chemotherapy,” reported Rudolph Navari, MD, PhD, of the World Health Organization, Geneva, and his associates (N Engl J Med. 2016;375:134-42).
Patients were randomized to receive olanzapine or the placebo, along with a 5-HT3-receptor antagonist (either palonosetron intravenously, granisetron intravenously or orally, or ondansetron intravenously or orally) and an NK1-receptor antagonist (fosaprepitant intravenously or aprepitant orally). The olanzapine (n = 192) and placebo (n = 188) groups were balanced with respect to age, race, sex, and chemotherapy administered.
Patients kept daily records of nausea and episodes of vomiting. The proportion of patients who reported no nausea or who experienced no clinically significant nausea was significantly greater in the olanzapine group than in the placebo group (37% vs. 22%, P = .002 and 67% vs. 49%, P = .001).
Patients receiving olanzapine had significantly increased sedation (severe in 5%) on day 2 compared with baseline, Dr. Navari and his associates reported. The sedation resolved on days 3, 4, and 5 even though patients continued to receive the drug on days 3 and 4. No patients discontinued the study because of sedation.
The National Cancer Institute funded the study. One investigator reported receiving financial support from Merck and Co. The other investigators reported having no disclosures.
On Twitter @jessnicolecraig
Olanzapine is more effective than placebo, in combination with a 5-HT3-receptor antagonist and an NK1-receptor antagonist, in preventing nausea in patients undergoing chemotherapy, according to investigators.
“This large, randomized, double-blind, placebo-controlled, phase III trial showed that it is more effective to combine olanzapine than placebo with an NK1-receptor antagonist, a 5-HT3–receptor antagonist, and dexamethasone for the prevention of nausea and vomiting in patients who have not received previous chemotherapy but are currently receiving highly emetogenic chemotherapy,” reported Rudolph Navari, MD, PhD, of the World Health Organization, Geneva, and his associates (N Engl J Med. 2016;375:134-42).
Patients were randomized to receive olanzapine or the placebo, along with a 5-HT3-receptor antagonist (either palonosetron intravenously, granisetron intravenously or orally, or ondansetron intravenously or orally) and an NK1-receptor antagonist (fosaprepitant intravenously or aprepitant orally). The olanzapine (n = 192) and placebo (n = 188) groups were balanced with respect to age, race, sex, and chemotherapy administered.
Patients kept daily records of nausea and episodes of vomiting. The proportion of patients who reported no nausea or who experienced no clinically significant nausea was significantly greater in the olanzapine group than in the placebo group (37% vs. 22%, P = .002 and 67% vs. 49%, P = .001).
Patients receiving olanzapine had significantly increased sedation (severe in 5%) on day 2 compared with baseline, Dr. Navari and his associates reported. The sedation resolved on days 3, 4, and 5 even though patients continued to receive the drug on days 3 and 4. No patients discontinued the study because of sedation.
The National Cancer Institute funded the study. One investigator reported receiving financial support from Merck and Co. The other investigators reported having no disclosures.
On Twitter @jessnicolecraig
Olanzapine is more effective than placebo, in combination with a 5-HT3-receptor antagonist and an NK1-receptor antagonist, in preventing nausea in patients undergoing chemotherapy, according to investigators.
“This large, randomized, double-blind, placebo-controlled, phase III trial showed that it is more effective to combine olanzapine than placebo with an NK1-receptor antagonist, a 5-HT3–receptor antagonist, and dexamethasone for the prevention of nausea and vomiting in patients who have not received previous chemotherapy but are currently receiving highly emetogenic chemotherapy,” reported Rudolph Navari, MD, PhD, of the World Health Organization, Geneva, and his associates (N Engl J Med. 2016;375:134-42).
Patients were randomized to receive olanzapine or the placebo, along with a 5-HT3-receptor antagonist (either palonosetron intravenously, granisetron intravenously or orally, or ondansetron intravenously or orally) and an NK1-receptor antagonist (fosaprepitant intravenously or aprepitant orally). The olanzapine (n = 192) and placebo (n = 188) groups were balanced with respect to age, race, sex, and chemotherapy administered.
Patients kept daily records of nausea and episodes of vomiting. The proportion of patients who reported no nausea or who experienced no clinically significant nausea was significantly greater in the olanzapine group than in the placebo group (37% vs. 22%, P = .002 and 67% vs. 49%, P = .001).
Patients receiving olanzapine had significantly increased sedation (severe in 5%) on day 2 compared with baseline, Dr. Navari and his associates reported. The sedation resolved on days 3, 4, and 5 even though patients continued to receive the drug on days 3 and 4. No patients discontinued the study because of sedation.
The National Cancer Institute funded the study. One investigator reported receiving financial support from Merck and Co. The other investigators reported having no disclosures.
On Twitter @jessnicolecraig
FROM THE NEW ENGLAND JOURNAL OF MEDICINE
Key clinical point: Olanzapine significantly reduced episodes of nausea, compared with placebo.
Major finding: The proportion of patients who experienced no clinically significant nausea was significantly greater in the olanzapine group than in the placebo group (67% vs. 49%, P = .001).
Data source: A randomized, double-blind phase III trial of 380 patients receiving chemotherapy for malignant cancer.
Disclosures: The National Cancer Institute funded the study. One investigator reported receiving financial support from Merck and Co. The other investigators reported having no disclosures.
Cord blood cell infusions reduce cGVHD incidence
Repeat infusions of mesenchymal stromal stem cells appear to inhibit the development of chronic graft-versus-host disease (cGVHD) in patients who have undergone an allogeneic stem cell transplant.
The 2-year cumulative incidence of cGVHD among those randomized to receive repeated infusions of umbilical cord–derived mesenchymal stromal cells (MSCs) was half that of controls treated with a saline placebo, based on results from a randomized phase II, double blind trial in 124 patients with hematologic malignancies who underwent an HLA-haploidentical allogeneic hematopoietic stem cell transplantation (HSCT).
“Our goal was to minimize the incidence of cGVHD, reduce the severity of cGVHD, and demonstrate the safety of MSC infusions. We performed repeated infusions of MSCs once a month for a total of four rounds for each patient. Over the median 47-month posttransplantation period, the incidence of cGVHD was lower in the MSCs group than in the non-MSCs control group,” Lei Gao, MD, of the Third Military Medical University in Chongqing, China, and colleagues wrote in the Journal of Clinical Oncology (2016 Jul 11. doi: 10.1200/JCO.2015.65.3642).
Although cGVHD is associated with a reduced risk of leukemia relapse, it is still the leading cause of nonrelapse deaths after HSCT. The incidence of cGVHD is higher among recipients of HLA-haploidentical HSCT, in which the donor and recipient have identical HLA alleles on only one copy of chromosome, than among HLA-matched recipients, who have identical alleles on both copies.
The researchers randomly assigned 124 patients who had undergo HLA-haploidentical HSCT to receive either placebo or MSCs at a dose of 3 x 107 cells/100 mL per month for four cycles beginning 4 months after HSCT
Of the 124 randomized patients, 12 discontinued the study due to cGVHD or disease progression.
The 2-year cumulative incidence of cGVHD among patients treated with MSCs was 27%, compared with 49% for placebo-treated controls (P = .021). Seven patients in the control group but none in the MSC-treated group developed typical lung cGVHD (P = .047).
The investigators also observed increases in memory B lymphocytes and regulatory T cells, and in the ratio of type 1 to type 2 T-helper cells, as well as a decrease in natural killer cells.
The finding that the MSC infusions increased the number of regulatory T cells while decreasing the incidence of cGVHD suggests that regulatory T cells play an inhibitory role, the investigators said.
The study was supported by the Chinese Academy of Sciences. Chinese National Natural Science Foundation, and other Chinese government grants. The authors reported having no relationships to disclose.
On the basis of the Gao et al. study, future investigations of cGVHD prophylaxis using MSCs should be explored. Approximately 90% of their population was younger than age 40, however, and it will be interesting to observe if this strategy is effective in older adults. The permutations and combinations for using different cell sources for deriving the MSCs, and in the context of different neoplastic disease, type and stage, conditioning regimen intensity, GVHD prophylaxis, graft and donor source, among other variables, are daunting. Nonetheless, the results of their trial encourage us to further explore this approach.
Hillard M. Lazarus, MD, is with Case Western Reserve University, Cleveland. Steven Z. Pavletic, MD, is with the National Institutes of Health, Bethesda, Md. Their comments were taken from an accompanying editorial (J Clin Oncol. 2016 Jul 11. doi: 10.1200/JCO.2016.67.7344).
On the basis of the Gao et al. study, future investigations of cGVHD prophylaxis using MSCs should be explored. Approximately 90% of their population was younger than age 40, however, and it will be interesting to observe if this strategy is effective in older adults. The permutations and combinations for using different cell sources for deriving the MSCs, and in the context of different neoplastic disease, type and stage, conditioning regimen intensity, GVHD prophylaxis, graft and donor source, among other variables, are daunting. Nonetheless, the results of their trial encourage us to further explore this approach.
Hillard M. Lazarus, MD, is with Case Western Reserve University, Cleveland. Steven Z. Pavletic, MD, is with the National Institutes of Health, Bethesda, Md. Their comments were taken from an accompanying editorial (J Clin Oncol. 2016 Jul 11. doi: 10.1200/JCO.2016.67.7344).
On the basis of the Gao et al. study, future investigations of cGVHD prophylaxis using MSCs should be explored. Approximately 90% of their population was younger than age 40, however, and it will be interesting to observe if this strategy is effective in older adults. The permutations and combinations for using different cell sources for deriving the MSCs, and in the context of different neoplastic disease, type and stage, conditioning regimen intensity, GVHD prophylaxis, graft and donor source, among other variables, are daunting. Nonetheless, the results of their trial encourage us to further explore this approach.
Hillard M. Lazarus, MD, is with Case Western Reserve University, Cleveland. Steven Z. Pavletic, MD, is with the National Institutes of Health, Bethesda, Md. Their comments were taken from an accompanying editorial (J Clin Oncol. 2016 Jul 11. doi: 10.1200/JCO.2016.67.7344).
Repeat infusions of mesenchymal stromal stem cells appear to inhibit the development of chronic graft-versus-host disease (cGVHD) in patients who have undergone an allogeneic stem cell transplant.
The 2-year cumulative incidence of cGVHD among those randomized to receive repeated infusions of umbilical cord–derived mesenchymal stromal cells (MSCs) was half that of controls treated with a saline placebo, based on results from a randomized phase II, double blind trial in 124 patients with hematologic malignancies who underwent an HLA-haploidentical allogeneic hematopoietic stem cell transplantation (HSCT).
“Our goal was to minimize the incidence of cGVHD, reduce the severity of cGVHD, and demonstrate the safety of MSC infusions. We performed repeated infusions of MSCs once a month for a total of four rounds for each patient. Over the median 47-month posttransplantation period, the incidence of cGVHD was lower in the MSCs group than in the non-MSCs control group,” Lei Gao, MD, of the Third Military Medical University in Chongqing, China, and colleagues wrote in the Journal of Clinical Oncology (2016 Jul 11. doi: 10.1200/JCO.2015.65.3642).
Although cGVHD is associated with a reduced risk of leukemia relapse, it is still the leading cause of nonrelapse deaths after HSCT. The incidence of cGVHD is higher among recipients of HLA-haploidentical HSCT, in which the donor and recipient have identical HLA alleles on only one copy of chromosome, than among HLA-matched recipients, who have identical alleles on both copies.
The researchers randomly assigned 124 patients who had undergo HLA-haploidentical HSCT to receive either placebo or MSCs at a dose of 3 x 107 cells/100 mL per month for four cycles beginning 4 months after HSCT
Of the 124 randomized patients, 12 discontinued the study due to cGVHD or disease progression.
The 2-year cumulative incidence of cGVHD among patients treated with MSCs was 27%, compared with 49% for placebo-treated controls (P = .021). Seven patients in the control group but none in the MSC-treated group developed typical lung cGVHD (P = .047).
The investigators also observed increases in memory B lymphocytes and regulatory T cells, and in the ratio of type 1 to type 2 T-helper cells, as well as a decrease in natural killer cells.
The finding that the MSC infusions increased the number of regulatory T cells while decreasing the incidence of cGVHD suggests that regulatory T cells play an inhibitory role, the investigators said.
The study was supported by the Chinese Academy of Sciences. Chinese National Natural Science Foundation, and other Chinese government grants. The authors reported having no relationships to disclose.
Repeat infusions of mesenchymal stromal stem cells appear to inhibit the development of chronic graft-versus-host disease (cGVHD) in patients who have undergone an allogeneic stem cell transplant.
The 2-year cumulative incidence of cGVHD among those randomized to receive repeated infusions of umbilical cord–derived mesenchymal stromal cells (MSCs) was half that of controls treated with a saline placebo, based on results from a randomized phase II, double blind trial in 124 patients with hematologic malignancies who underwent an HLA-haploidentical allogeneic hematopoietic stem cell transplantation (HSCT).
“Our goal was to minimize the incidence of cGVHD, reduce the severity of cGVHD, and demonstrate the safety of MSC infusions. We performed repeated infusions of MSCs once a month for a total of four rounds for each patient. Over the median 47-month posttransplantation period, the incidence of cGVHD was lower in the MSCs group than in the non-MSCs control group,” Lei Gao, MD, of the Third Military Medical University in Chongqing, China, and colleagues wrote in the Journal of Clinical Oncology (2016 Jul 11. doi: 10.1200/JCO.2015.65.3642).
Although cGVHD is associated with a reduced risk of leukemia relapse, it is still the leading cause of nonrelapse deaths after HSCT. The incidence of cGVHD is higher among recipients of HLA-haploidentical HSCT, in which the donor and recipient have identical HLA alleles on only one copy of chromosome, than among HLA-matched recipients, who have identical alleles on both copies.
The researchers randomly assigned 124 patients who had undergo HLA-haploidentical HSCT to receive either placebo or MSCs at a dose of 3 x 107 cells/100 mL per month for four cycles beginning 4 months after HSCT
Of the 124 randomized patients, 12 discontinued the study due to cGVHD or disease progression.
The 2-year cumulative incidence of cGVHD among patients treated with MSCs was 27%, compared with 49% for placebo-treated controls (P = .021). Seven patients in the control group but none in the MSC-treated group developed typical lung cGVHD (P = .047).
The investigators also observed increases in memory B lymphocytes and regulatory T cells, and in the ratio of type 1 to type 2 T-helper cells, as well as a decrease in natural killer cells.
The finding that the MSC infusions increased the number of regulatory T cells while decreasing the incidence of cGVHD suggests that regulatory T cells play an inhibitory role, the investigators said.
The study was supported by the Chinese Academy of Sciences. Chinese National Natural Science Foundation, and other Chinese government grants. The authors reported having no relationships to disclose.
FROM JOURNAL OF CLINICAL ONCOLOGY
Key clinical point: Mesenchymal stromal cell infusions may reduce risk of chronic graft-versus-host disease following allogeneic stem cell transplants.
Major finding: The 2-year cumulative incidence of cGVHD among patients treated with MSCs was 27.4%, compared with 49% for placebo-treated controls.
Data source: Randomized, double-blind, controlled trial in 124 patients following HSCT for hematologic malignancies.
Disclosures: The study was supported by the Chinese Academy of Sciences. Chinese National Natural Science Foundation, and other Chinese government grants. The authors reported having no relationships to disclose.
Lack of hematology-specific measures not barrier to quality end of life care
Standard oncology measures are acceptable indicators of good-quality end of life care for hematologic malignancies, investigators report.
Six out of eight standard end of life (EOL) care measures were deemed acceptable (defined as greater than 55% agreement) based on 349 returned surveys from hematologic oncologists. Hospice enrollment more than 7 days before death, no chemotherapy less than 14 days before death, and no CPR and intubation within the last 30 days of life were acceptable measures to more than 75% of those surveyed.
No more than one hospitalization within 30 days of death and no more than one emergency room visit within 30 days of death did not meet the threshold for acceptance by the oncologists.
“These data suggest that the absence of hematology-specific measures is unlikely to be a major barrier to quality care and that more resources should be directed toward addressing barriers to compliance with established EOL quality measures than toward creating new ones,” Oreofe O. Odejide, MD, of the Dana-Farber Cancer Institute, Boston, and her associates reported (J Clin Oncol. 2016 July. doi: 10.1200/JCO.2016.67.8177).
The top barriers to end of life care were unrealistic patient expectations (97.3%), clinician concern about diminishing patient and family hope (71.3%), and unrealistic clinician expectations (59.0%), according to investigators.
Surveyed oncologists also reported that increasing access to palliative care services (93.7%), increasing access to inpatient hospice facilities (92.2%), and allowing hospice enrollment with disease-directed treatment (90.1%) would be the most helpful interventions to improve end of life care.
The Lymphoma Research Foundation, the Conquer Cancer Foundation, and investigators’ respective institutions funded this research. Dr. Odejide and four of her associates had no disclosures to report. Two investigators reported serving in advisory roles, holding patents, or having stock or ownership interest in UnitedHealthcare, UpToDate, or Recap Information Systems.
On Twitter @jessnicolecraig
Standard oncology measures are acceptable indicators of good-quality end of life care for hematologic malignancies, investigators report.
Six out of eight standard end of life (EOL) care measures were deemed acceptable (defined as greater than 55% agreement) based on 349 returned surveys from hematologic oncologists. Hospice enrollment more than 7 days before death, no chemotherapy less than 14 days before death, and no CPR and intubation within the last 30 days of life were acceptable measures to more than 75% of those surveyed.
No more than one hospitalization within 30 days of death and no more than one emergency room visit within 30 days of death did not meet the threshold for acceptance by the oncologists.
“These data suggest that the absence of hematology-specific measures is unlikely to be a major barrier to quality care and that more resources should be directed toward addressing barriers to compliance with established EOL quality measures than toward creating new ones,” Oreofe O. Odejide, MD, of the Dana-Farber Cancer Institute, Boston, and her associates reported (J Clin Oncol. 2016 July. doi: 10.1200/JCO.2016.67.8177).
The top barriers to end of life care were unrealistic patient expectations (97.3%), clinician concern about diminishing patient and family hope (71.3%), and unrealistic clinician expectations (59.0%), according to investigators.
Surveyed oncologists also reported that increasing access to palliative care services (93.7%), increasing access to inpatient hospice facilities (92.2%), and allowing hospice enrollment with disease-directed treatment (90.1%) would be the most helpful interventions to improve end of life care.
The Lymphoma Research Foundation, the Conquer Cancer Foundation, and investigators’ respective institutions funded this research. Dr. Odejide and four of her associates had no disclosures to report. Two investigators reported serving in advisory roles, holding patents, or having stock or ownership interest in UnitedHealthcare, UpToDate, or Recap Information Systems.
On Twitter @jessnicolecraig
Standard oncology measures are acceptable indicators of good-quality end of life care for hematologic malignancies, investigators report.
Six out of eight standard end of life (EOL) care measures were deemed acceptable (defined as greater than 55% agreement) based on 349 returned surveys from hematologic oncologists. Hospice enrollment more than 7 days before death, no chemotherapy less than 14 days before death, and no CPR and intubation within the last 30 days of life were acceptable measures to more than 75% of those surveyed.
No more than one hospitalization within 30 days of death and no more than one emergency room visit within 30 days of death did not meet the threshold for acceptance by the oncologists.
“These data suggest that the absence of hematology-specific measures is unlikely to be a major barrier to quality care and that more resources should be directed toward addressing barriers to compliance with established EOL quality measures than toward creating new ones,” Oreofe O. Odejide, MD, of the Dana-Farber Cancer Institute, Boston, and her associates reported (J Clin Oncol. 2016 July. doi: 10.1200/JCO.2016.67.8177).
The top barriers to end of life care were unrealistic patient expectations (97.3%), clinician concern about diminishing patient and family hope (71.3%), and unrealistic clinician expectations (59.0%), according to investigators.
Surveyed oncologists also reported that increasing access to palliative care services (93.7%), increasing access to inpatient hospice facilities (92.2%), and allowing hospice enrollment with disease-directed treatment (90.1%) would be the most helpful interventions to improve end of life care.
The Lymphoma Research Foundation, the Conquer Cancer Foundation, and investigators’ respective institutions funded this research. Dr. Odejide and four of her associates had no disclosures to report. Two investigators reported serving in advisory roles, holding patents, or having stock or ownership interest in UnitedHealthcare, UpToDate, or Recap Information Systems.
On Twitter @jessnicolecraig
FROM THE JOURNAL OF CLINICAL ONCOLOGY
Key clinical point: Standard measures are acceptable indicators of good quality end of life care for patients with hematologic malignancies.
Major finding: All but two standard measures developed for solid tumors were found to be acceptable (defined as greater than 55% agreement) indicators of good quality end of life care for hematologic malignancies.
Data source: A national, pilot-tested survey of 349 hematologic oncologists.
Disclosures: In addition to internal funding, the Lymphoma Research Foundation and the Conquer Cancer Foundation funded this research. Dr. Odejide and four of her associates had no disclosures to report. Two investigators reported serving in advisory roles, holding patents, or having stock or ownership interest in UnitedHealthcare, UpToDate, or Recap Information Systems.