Patient & Survivor Care

SAN DIEGO – Teens with chronic illnesses who participated in a program that consisted of mind-body principles and peer support demonstrated statistically significant positive changes in physical and mental well-being, anger, tension, and stress, in a pilot study.

“Young people living with serious chronic illnesses must deal not only with the physical effects and uncomfortable symptoms of their conditions, but must also endure significant psychosocial effects,” Dr. Brittany Blockman said in an interview in advance of the annual meeting of the Pediatric Academic Societies. “As we learn more about the impact of stress not only on mental health but also physical health, it will be important to design interventions and programs that address this vital, yet sometimes intangible area of health.”

Mind-body medicine focuses on the ways in which emotional, mental, social, and spiritual factors can directly impact health, said Dr. Blockman, a resident physician for the University of California, San Francisco’s Pediatric Leadership for the Underserved program. “Mind-body skills can enhance an individual’s sense of control and have been demonstrated to lower sympathetic arousal, decrease anxiety, and improve mood. Some examples of these modalities include meditation, mindfulness practices, breath work, yoga, biofeedback, and guided imagery. There is a growing body of literature reporting the positive physical and psychological health benefits of mind-body group interventions in various adult populations living with chronic illnesses, including improvements in quality of life, mood, pain, stress, coping skills, disease progression, and mortality. However, there is limited research exploring similar mind-body and group support interventions in pediatric and adolescent populations.”

Dr. Blockman and her associates enrolled 10 teens aged 13-18 years with chronic illnesses, and their parents, to study the impact of Communitas, a novel program that provides mind-body skills and peer support. Teens and parents met in separate groups 10 times for 2 hours at a time. Each session consisted of meditation, a lesson on guided imagery or some other mind-body technique, an exercise, and group sharing. The National Institutes of Health (NIH) Patient Reported Outcomes Measurement Information System (PROMIS) Global Health Scale, the Profile of Mood States (POMS), the Brief COPE scale, the Mindfulness Attention Awareness Scale (MAAS), the Perceived Stress Scale, and the Resilience Scale were administered before and after the 10 sessions.

The majority of teens (80%) were female; they attended an average of 7.3 sessions. Illnesses represented included juvenile idiopathic arthritis, cerebral palsy, type 1 diabetes, cancer, muscular dystrophy, cystic fibrosis, lung disease, spinal cord injury, and Wegener’s granulomatosis. Of the nine parents who participated, 75% were female; they completed an average of 7.5 sessions.

When Dr. Blockman and her associates compared baseline teen responses with those immediately after the 10-session intervention, they observed statistically significant effects on a number of scales, including the physical well-being subscale of the NIH PROMIS Global Health Scale (a mean increase of 1.56; P = .047); the mental well-being subscale of the NIH PROMIS Global Health Scale (a mean increase of 2.33; P = .025); the anger subscale of the POMS (a mean decrease of .54; P = .039); the tension subscale of the POMS (a mean decrease of .78; P = .006); the distraction/disengagement subscale of the Brief Cope (a mean decrease of .84; P = .035); and the Perceived Stress Scale (a mean decrease of 3.89; P = .005). The results for adults are still being analyzed.

“I was surprised at how willing the adolescents were to participate in the intervention and how engaged they were in the practices that were taught,” Dr. Blockman said. “It is our hope that the results of this study are helpful in thinking about the types of innovative interventions that may be useful in treating, healing, and supporting adolescents living with chronic illness, as well as their family members.”

She acknowledged certain limitations of the study, including the small sample size and the fact that there was no comparison group. “In the future, we plan to test our intervention further in a controlled trial design study, with a larger sample size. Another limitation is we cannot easily evaluate whether our positive results were attributable to the intervention content or the supportive nature of the intervention group. Our qualitative data may help us in teasing this apart.”

Dr. Blockman reported having no relevant financial conflicts.

[email protected]

On Twitter @dougbrunk

SAN DIEGO – Teens with chronic illnesses who participated in a program that consisted of mind-body principles and peer support demonstrated statistically significant positive changes in physical and mental well-being, anger, tension, and stress, in a pilot study.

“Young people living with serious chronic illnesses must deal not only with the physical effects and uncomfortable symptoms of their conditions, but must also endure significant psychosocial effects,” Dr. Brittany Blockman said in an interview in advance of the annual meeting of the Pediatric Academic Societies. “As we learn more about the impact of stress not only on mental health but also physical health, it will be important to design interventions and programs that address this vital, yet sometimes intangible area of health.”

Mind-body medicine focuses on the ways in which emotional, mental, social, and spiritual factors can directly impact health, said Dr. Blockman, a resident physician for the University of California, San Francisco’s Pediatric Leadership for the Underserved program. “Mind-body skills can enhance an individual’s sense of control and have been demonstrated to lower sympathetic arousal, decrease anxiety, and improve mood. Some examples of these modalities include meditation, mindfulness practices, breath work, yoga, biofeedback, and guided imagery. There is a growing body of literature reporting the positive physical and psychological health benefits of mind-body group interventions in various adult populations living with chronic illnesses, including improvements in quality of life, mood, pain, stress, coping skills, disease progression, and mortality. However, there is limited research exploring similar mind-body and group support interventions in pediatric and adolescent populations.”

Dr. Blockman and her associates enrolled 10 teens aged 13-18 years with chronic illnesses, and their parents, to study the impact of Communitas, a novel program that provides mind-body skills and peer support. Teens and parents met in separate groups 10 times for 2 hours at a time. Each session consisted of meditation, a lesson on guided imagery or some other mind-body technique, an exercise, and group sharing. The National Institutes of Health (NIH) Patient Reported Outcomes Measurement Information System (PROMIS) Global Health Scale, the Profile of Mood States (POMS), the Brief COPE scale, the Mindfulness Attention Awareness Scale (MAAS), the Perceived Stress Scale, and the Resilience Scale were administered before and after the 10 sessions.

The majority of teens (80%) were female; they attended an average of 7.3 sessions. Illnesses represented included juvenile idiopathic arthritis, cerebral palsy, type 1 diabetes, cancer, muscular dystrophy, cystic fibrosis, lung disease, spinal cord injury, and Wegener’s granulomatosis. Of the nine parents who participated, 75% were female; they completed an average of 7.5 sessions.

When Dr. Blockman and her associates compared baseline teen responses with those immediately after the 10-session intervention, they observed statistically significant effects on a number of scales, including the physical well-being subscale of the NIH PROMIS Global Health Scale (a mean increase of 1.56; P = .047); the mental well-being subscale of the NIH PROMIS Global Health Scale (a mean increase of 2.33; P = .025); the anger subscale of the POMS (a mean decrease of .54; P = .039); the tension subscale of the POMS (a mean decrease of .78; P = .006); the distraction/disengagement subscale of the Brief Cope (a mean decrease of .84; P = .035); and the Perceived Stress Scale (a mean decrease of 3.89; P = .005). The results for adults are still being analyzed.

“I was surprised at how willing the adolescents were to participate in the intervention and how engaged they were in the practices that were taught,” Dr. Blockman said. “It is our hope that the results of this study are helpful in thinking about the types of innovative interventions that may be useful in treating, healing, and supporting adolescents living with chronic illness, as well as their family members.”

She acknowledged certain limitations of the study, including the small sample size and the fact that there was no comparison group. “In the future, we plan to test our intervention further in a controlled trial design study, with a larger sample size. Another limitation is we cannot easily evaluate whether our positive results were attributable to the intervention content or the supportive nature of the intervention group. Our qualitative data may help us in teasing this apart.”

Dr. Blockman reported having no relevant financial conflicts.

[email protected]

On Twitter @dougbrunk

SAN DIEGO – Teens with chronic illnesses who participated in a program that consisted of mind-body principles and peer support demonstrated statistically significant positive changes in physical and mental well-being, anger, tension, and stress, in a pilot study.

“Young people living with serious chronic illnesses must deal not only with the physical effects and uncomfortable symptoms of their conditions, but must also endure significant psychosocial effects,” Dr. Brittany Blockman said in an interview in advance of the annual meeting of the Pediatric Academic Societies. “As we learn more about the impact of stress not only on mental health but also physical health, it will be important to design interventions and programs that address this vital, yet sometimes intangible area of health.”

Mind-body medicine focuses on the ways in which emotional, mental, social, and spiritual factors can directly impact health, said Dr. Blockman, a resident physician for the University of California, San Francisco’s Pediatric Leadership for the Underserved program. “Mind-body skills can enhance an individual’s sense of control and have been demonstrated to lower sympathetic arousal, decrease anxiety, and improve mood. Some examples of these modalities include meditation, mindfulness practices, breath work, yoga, biofeedback, and guided imagery. There is a growing body of literature reporting the positive physical and psychological health benefits of mind-body group interventions in various adult populations living with chronic illnesses, including improvements in quality of life, mood, pain, stress, coping skills, disease progression, and mortality. However, there is limited research exploring similar mind-body and group support interventions in pediatric and adolescent populations.”

Dr. Blockman and her associates enrolled 10 teens aged 13-18 years with chronic illnesses, and their parents, to study the impact of Communitas, a novel program that provides mind-body skills and peer support. Teens and parents met in separate groups 10 times for 2 hours at a time. Each session consisted of meditation, a lesson on guided imagery or some other mind-body technique, an exercise, and group sharing. The National Institutes of Health (NIH) Patient Reported Outcomes Measurement Information System (PROMIS) Global Health Scale, the Profile of Mood States (POMS), the Brief COPE scale, the Mindfulness Attention Awareness Scale (MAAS), the Perceived Stress Scale, and the Resilience Scale were administered before and after the 10 sessions.

The majority of teens (80%) were female; they attended an average of 7.3 sessions. Illnesses represented included juvenile idiopathic arthritis, cerebral palsy, type 1 diabetes, cancer, muscular dystrophy, cystic fibrosis, lung disease, spinal cord injury, and Wegener’s granulomatosis. Of the nine parents who participated, 75% were female; they completed an average of 7.5 sessions.

When Dr. Blockman and her associates compared baseline teen responses with those immediately after the 10-session intervention, they observed statistically significant effects on a number of scales, including the physical well-being subscale of the NIH PROMIS Global Health Scale (a mean increase of 1.56; P = .047); the mental well-being subscale of the NIH PROMIS Global Health Scale (a mean increase of 2.33; P = .025); the anger subscale of the POMS (a mean decrease of .54; P = .039); the tension subscale of the POMS (a mean decrease of .78; P = .006); the distraction/disengagement subscale of the Brief Cope (a mean decrease of .84; P = .035); and the Perceived Stress Scale (a mean decrease of 3.89; P = .005). The results for adults are still being analyzed.

“I was surprised at how willing the adolescents were to participate in the intervention and how engaged they were in the practices that were taught,” Dr. Blockman said. “It is our hope that the results of this study are helpful in thinking about the types of innovative interventions that may be useful in treating, healing, and supporting adolescents living with chronic illness, as well as their family members.”

She acknowledged certain limitations of the study, including the small sample size and the fact that there was no comparison group. “In the future, we plan to test our intervention further in a controlled trial design study, with a larger sample size. Another limitation is we cannot easily evaluate whether our positive results were attributable to the intervention content or the supportive nature of the intervention group. Our qualitative data may help us in teasing this apart.”

Dr. Blockman reported having no relevant financial conflicts.

[email protected]

On Twitter @dougbrunk

Nearly two-thirds of older women receiving trastuzumab for breast cancer do not get adequate cardiac monitoring, despite the known risks for cardiotoxicity, investigators reported.

Only 36% of 2,203 patients with a median age of 72 years who received trastuzumab (Herceptin)-based adjuvant therapy had adequate cardiac monitoring, based on a review (J. Clin. Oncol 2015 May 11 [doi:10.1200/JCO.2014.58.9465]).

“Our study shows that cardiac monitoring is an area that requires improvement. Actions to increase the rates of cardiac monitoring in this vulnerable population are needed, and adequate cardiac monitoring among trastuzumab-treated patients should be considered a marker of quality of care. Efforts to further disseminate current guidelines should be a priority for our hospitals, training programs, and medical societies,” wrote Dr. Mariana Chavez-MacGregor and colleagues from the University of Texas MD Anderson Cancer Center in Houston.

The authors reviewed Medicare data on patients aged 66 years and older with stage I-III breast cancer treated with trastuzumab-based therapy. They found that 79% of the patients had a baseline cardiac evaluation and that 68% had cardiac tests within 4 months of starting on therapy. Only 43% of patients, however, received subsequent monitoring once every 4 months as recommended in treatment guidelines, and only 36% received optimal monitoring with baseline exam and scheduled follow-up evaluations, the researchers reported.

In multivariable models controlling for demographic/socioeconomic factors (age, race, marital status, education, income, urban/rural residence), clinical stage, comorbidities, and anthracycline and taxane use, factors associated with the likelihood of getting optimal monitoring included more recent year of diagnosis, anthracycline exposure, female prescribing physician, and physician age. Physicians who graduated from medical school after 1990 were significantly more likely to recommend monitoring.

“We estimated the relative contributions of physician and patient-level effects to the variance of the observation; 15.3% of the variance in the adequacy of cardiac monitoring was attributable to physician factors, and only 5.2% of the variance was attributable to measured patient factors,” the authors wrote.

Dr. Chavez-MacGregor disclosed financial relationships with Genomic Health, Roche, and Novartis.

Nearly two-thirds of older women receiving trastuzumab for breast cancer do not get adequate cardiac monitoring, despite the known risks for cardiotoxicity, investigators reported.

Only 36% of 2,203 patients with a median age of 72 years who received trastuzumab (Herceptin)-based adjuvant therapy had adequate cardiac monitoring, based on a review (J. Clin. Oncol 2015 May 11 [doi:10.1200/JCO.2014.58.9465]).

“Our study shows that cardiac monitoring is an area that requires improvement. Actions to increase the rates of cardiac monitoring in this vulnerable population are needed, and adequate cardiac monitoring among trastuzumab-treated patients should be considered a marker of quality of care. Efforts to further disseminate current guidelines should be a priority for our hospitals, training programs, and medical societies,” wrote Dr. Mariana Chavez-MacGregor and colleagues from the University of Texas MD Anderson Cancer Center in Houston.

The authors reviewed Medicare data on patients aged 66 years and older with stage I-III breast cancer treated with trastuzumab-based therapy. They found that 79% of the patients had a baseline cardiac evaluation and that 68% had cardiac tests within 4 months of starting on therapy. Only 43% of patients, however, received subsequent monitoring once every 4 months as recommended in treatment guidelines, and only 36% received optimal monitoring with baseline exam and scheduled follow-up evaluations, the researchers reported.

In multivariable models controlling for demographic/socioeconomic factors (age, race, marital status, education, income, urban/rural residence), clinical stage, comorbidities, and anthracycline and taxane use, factors associated with the likelihood of getting optimal monitoring included more recent year of diagnosis, anthracycline exposure, female prescribing physician, and physician age. Physicians who graduated from medical school after 1990 were significantly more likely to recommend monitoring.

“We estimated the relative contributions of physician and patient-level effects to the variance of the observation; 15.3% of the variance in the adequacy of cardiac monitoring was attributable to physician factors, and only 5.2% of the variance was attributable to measured patient factors,” the authors wrote.

Dr. Chavez-MacGregor disclosed financial relationships with Genomic Health, Roche, and Novartis.

Nearly two-thirds of older women receiving trastuzumab for breast cancer do not get adequate cardiac monitoring, despite the known risks for cardiotoxicity, investigators reported.

Only 36% of 2,203 patients with a median age of 72 years who received trastuzumab (Herceptin)-based adjuvant therapy had adequate cardiac monitoring, based on a review (J. Clin. Oncol 2015 May 11 [doi:10.1200/JCO.2014.58.9465]).

“Our study shows that cardiac monitoring is an area that requires improvement. Actions to increase the rates of cardiac monitoring in this vulnerable population are needed, and adequate cardiac monitoring among trastuzumab-treated patients should be considered a marker of quality of care. Efforts to further disseminate current guidelines should be a priority for our hospitals, training programs, and medical societies,” wrote Dr. Mariana Chavez-MacGregor and colleagues from the University of Texas MD Anderson Cancer Center in Houston.

The authors reviewed Medicare data on patients aged 66 years and older with stage I-III breast cancer treated with trastuzumab-based therapy. They found that 79% of the patients had a baseline cardiac evaluation and that 68% had cardiac tests within 4 months of starting on therapy. Only 43% of patients, however, received subsequent monitoring once every 4 months as recommended in treatment guidelines, and only 36% received optimal monitoring with baseline exam and scheduled follow-up evaluations, the researchers reported.

In multivariable models controlling for demographic/socioeconomic factors (age, race, marital status, education, income, urban/rural residence), clinical stage, comorbidities, and anthracycline and taxane use, factors associated with the likelihood of getting optimal monitoring included more recent year of diagnosis, anthracycline exposure, female prescribing physician, and physician age. Physicians who graduated from medical school after 1990 were significantly more likely to recommend monitoring.

“We estimated the relative contributions of physician and patient-level effects to the variance of the observation; 15.3% of the variance in the adequacy of cardiac monitoring was attributable to physician factors, and only 5.2% of the variance was attributable to measured patient factors,” the authors wrote.

Dr. Chavez-MacGregor disclosed financial relationships with Genomic Health, Roche, and Novartis.

Aromatase inhibitor-induced arthralgia substantially improved in women who received omega-3 fatty acid capsules, as well as in those who took placebo, according to a study published online May 4 in the Journal of Clinical Oncology.

Brief Pain Inventory (BPI) worst pain scores were significantly lower than were baseline scores after treatment with O3-FAs and placebo. On the 10-point scale, the median scores reported by women taking O3-FAs were lower by 1.69, 1.74, and 2.23 at 6, 12, and 24 weeks, respectively (P < .001). For those taking placebo, the scores also were significantly lower: 1.36, 1.50, and 1.81 points at 6, 12, and 24 weeks respectively (P < .001). Differences between the groups were not significant, reported Dr. Dawn Hershman of the Herbert Irving Comprehensive Cancer Center, Columbia University, New York, and associates (J. Clin. Onc. 2015 May 4 [doi: 10.1200/JCO.2014.59.5595]).

©Clayton Hansen/iStockphoto.com

“The improvement in symptoms in both the treatment and placebo groups was unexpected. The magnitude of the expected placebo effect reported in the literature can vary from 6% to 59% and can be higher in symptom-management studies. We found an effect >50%,” Dr. Hershman and associates wrote.

The large placebo effect may have resulted from a number of factors, including the natural history of arthralgia (which can improve over time), the soy/corn oil ingredients in the placebo capsule, or O3-FA contamination in the placebo arm due to supplementation by patients.

There are no proven therapies for AI-associated arthralgia, and its mechanism is unclear. Evidence suggests that inflammation may play a role. Given that studies have shown O3-FAs may benefit symptoms of rheumatoid arthritis, this multicenter, placebo controlled trial evaluated whether O3-FAs reduce pain and stiffness in 249 women undergoing adjuvant AI therapy for early-stage breast cancer.

At week 12, patients who received O3-FAs had significantly decreased serum triglyceride levels (–22.1 mg/dL, P < .001) and increased HDL (2.9 mg/dL, P < .007). Triglyceride and HDL levels for the placebo arm did not significantly change, which suggests that O3-FA contamination in the placebo arm was not a factor in the high placebo effect. Other serum measures (cholesterol, CRP, and LDL) did not significantly change for either group, Dr. Hershman and associates said.

[email protected]

Aromatase inhibitor-induced arthralgia substantially improved in women who received omega-3 fatty acid capsules, as well as in those who took placebo, according to a study published online May 4 in the Journal of Clinical Oncology.

Brief Pain Inventory (BPI) worst pain scores were significantly lower than were baseline scores after treatment with O3-FAs and placebo. On the 10-point scale, the median scores reported by women taking O3-FAs were lower by 1.69, 1.74, and 2.23 at 6, 12, and 24 weeks, respectively (P < .001). For those taking placebo, the scores also were significantly lower: 1.36, 1.50, and 1.81 points at 6, 12, and 24 weeks respectively (P < .001). Differences between the groups were not significant, reported Dr. Dawn Hershman of the Herbert Irving Comprehensive Cancer Center, Columbia University, New York, and associates (J. Clin. Onc. 2015 May 4 [doi: 10.1200/JCO.2014.59.5595]).

©Clayton Hansen/iStockphoto.com

“The improvement in symptoms in both the treatment and placebo groups was unexpected. The magnitude of the expected placebo effect reported in the literature can vary from 6% to 59% and can be higher in symptom-management studies. We found an effect >50%,” Dr. Hershman and associates wrote.

The large placebo effect may have resulted from a number of factors, including the natural history of arthralgia (which can improve over time), the soy/corn oil ingredients in the placebo capsule, or O3-FA contamination in the placebo arm due to supplementation by patients.

There are no proven therapies for AI-associated arthralgia, and its mechanism is unclear. Evidence suggests that inflammation may play a role. Given that studies have shown O3-FAs may benefit symptoms of rheumatoid arthritis, this multicenter, placebo controlled trial evaluated whether O3-FAs reduce pain and stiffness in 249 women undergoing adjuvant AI therapy for early-stage breast cancer.

At week 12, patients who received O3-FAs had significantly decreased serum triglyceride levels (–22.1 mg/dL, P < .001) and increased HDL (2.9 mg/dL, P < .007). Triglyceride and HDL levels for the placebo arm did not significantly change, which suggests that O3-FA contamination in the placebo arm was not a factor in the high placebo effect. Other serum measures (cholesterol, CRP, and LDL) did not significantly change for either group, Dr. Hershman and associates said.

[email protected]

Aromatase inhibitor-induced arthralgia substantially improved in women who received omega-3 fatty acid capsules, as well as in those who took placebo, according to a study published online May 4 in the Journal of Clinical Oncology.

Brief Pain Inventory (BPI) worst pain scores were significantly lower than were baseline scores after treatment with O3-FAs and placebo. On the 10-point scale, the median scores reported by women taking O3-FAs were lower by 1.69, 1.74, and 2.23 at 6, 12, and 24 weeks, respectively (P < .001). For those taking placebo, the scores also were significantly lower: 1.36, 1.50, and 1.81 points at 6, 12, and 24 weeks respectively (P < .001). Differences between the groups were not significant, reported Dr. Dawn Hershman of the Herbert Irving Comprehensive Cancer Center, Columbia University, New York, and associates (J. Clin. Onc. 2015 May 4 [doi: 10.1200/JCO.2014.59.5595]).

©Clayton Hansen/iStockphoto.com

“The improvement in symptoms in both the treatment and placebo groups was unexpected. The magnitude of the expected placebo effect reported in the literature can vary from 6% to 59% and can be higher in symptom-management studies. We found an effect >50%,” Dr. Hershman and associates wrote.

The large placebo effect may have resulted from a number of factors, including the natural history of arthralgia (which can improve over time), the soy/corn oil ingredients in the placebo capsule, or O3-FA contamination in the placebo arm due to supplementation by patients.

There are no proven therapies for AI-associated arthralgia, and its mechanism is unclear. Evidence suggests that inflammation may play a role. Given that studies have shown O3-FAs may benefit symptoms of rheumatoid arthritis, this multicenter, placebo controlled trial evaluated whether O3-FAs reduce pain and stiffness in 249 women undergoing adjuvant AI therapy for early-stage breast cancer.

At week 12, patients who received O3-FAs had significantly decreased serum triglyceride levels (–22.1 mg/dL, P < .001) and increased HDL (2.9 mg/dL, P < .007). Triglyceride and HDL levels for the placebo arm did not significantly change, which suggests that O3-FA contamination in the placebo arm was not a factor in the high placebo effect. Other serum measures (cholesterol, CRP, and LDL) did not significantly change for either group, Dr. Hershman and associates said.

[email protected]

Children over 2 years of age with advanced cancer experience high physical and psychological symptom distress, resulting mostly from pain, fatigue, drowsiness, and irritability, according to a study published online April 27 in the Journal of Clinical Oncology.

In the Pediatric Quality of Life and Evaluation of Symptoms Technology (PediQUEST) Study, children often reported suffering from pain that is known to be treatable, wrote Dr. Joanne Wolfe, director of pediatric palliative care at Boston Children’s Hospital and division chief of pediatric palliative care service in the department of psychosocial oncology and palliative care at Dana-Farber Cancer Institute, Boston (J. Clin. Oncol. 2015 April 27 [doi: 10.1200/JCO.2014.59.1222]).

“The study makes it evident that there is considerable room for improvement in easing distress in children with advanced cancer. Children experienced substantial suffering from pain throughout the course of the illness and especially at the end of life,” they wrote.

Among 104 children enrolled in the study with 920 completed symptom assessments over a 9-month follow-up, pain was most frequently reported (48%), followed by fatigue (46%), drowsiness (39%), and nausea (35%). Emotional distress was prevalent as well: irritability (37%), sleep disturbance (29%), nervousness (25%), sadness (24%), and worrying (24%). High distress was indicated for most scores.

During the last 12 weeks of life, prevalence of symptoms and levels of high distress worsened. The prevalence of pain increased to 62%; 58% with high distress. Fatigue rose to 49%, and drowsiness to 50%.

To establish patient reported outcomes (PROs) for children, PediQUEST collects child-reported symptoms (or parent-reported when necessary) and HRQoL data via computer and generates feedback reports and email alerts.

Higher symptom scores were associated with several factors, including being female, having a brain tumor, having disease progression within the previous 10 days, and receiving moderate- to high-intensity cancer treatment within the previous 10 days.

“Implications from these findings are not necessarily to decrease the amount or intensity of cancer-directed therapy offered but rather to increase efforts to ameliorate symptom distress,” the investigators wrote.

Children over 2 years of age with advanced cancer experience high physical and psychological symptom distress, resulting mostly from pain, fatigue, drowsiness, and irritability, according to a study published online April 27 in the Journal of Clinical Oncology.

In the Pediatric Quality of Life and Evaluation of Symptoms Technology (PediQUEST) Study, children often reported suffering from pain that is known to be treatable, wrote Dr. Joanne Wolfe, director of pediatric palliative care at Boston Children’s Hospital and division chief of pediatric palliative care service in the department of psychosocial oncology and palliative care at Dana-Farber Cancer Institute, Boston (J. Clin. Oncol. 2015 April 27 [doi: 10.1200/JCO.2014.59.1222]).

“The study makes it evident that there is considerable room for improvement in easing distress in children with advanced cancer. Children experienced substantial suffering from pain throughout the course of the illness and especially at the end of life,” they wrote.

Among 104 children enrolled in the study with 920 completed symptom assessments over a 9-month follow-up, pain was most frequently reported (48%), followed by fatigue (46%), drowsiness (39%), and nausea (35%). Emotional distress was prevalent as well: irritability (37%), sleep disturbance (29%), nervousness (25%), sadness (24%), and worrying (24%). High distress was indicated for most scores.

During the last 12 weeks of life, prevalence of symptoms and levels of high distress worsened. The prevalence of pain increased to 62%; 58% with high distress. Fatigue rose to 49%, and drowsiness to 50%.

To establish patient reported outcomes (PROs) for children, PediQUEST collects child-reported symptoms (or parent-reported when necessary) and HRQoL data via computer and generates feedback reports and email alerts.

Higher symptom scores were associated with several factors, including being female, having a brain tumor, having disease progression within the previous 10 days, and receiving moderate- to high-intensity cancer treatment within the previous 10 days.

“Implications from these findings are not necessarily to decrease the amount or intensity of cancer-directed therapy offered but rather to increase efforts to ameliorate symptom distress,” the investigators wrote.

Children over 2 years of age with advanced cancer experience high physical and psychological symptom distress, resulting mostly from pain, fatigue, drowsiness, and irritability, according to a study published online April 27 in the Journal of Clinical Oncology.

In the Pediatric Quality of Life and Evaluation of Symptoms Technology (PediQUEST) Study, children often reported suffering from pain that is known to be treatable, wrote Dr. Joanne Wolfe, director of pediatric palliative care at Boston Children’s Hospital and division chief of pediatric palliative care service in the department of psychosocial oncology and palliative care at Dana-Farber Cancer Institute, Boston (J. Clin. Oncol. 2015 April 27 [doi: 10.1200/JCO.2014.59.1222]).

“The study makes it evident that there is considerable room for improvement in easing distress in children with advanced cancer. Children experienced substantial suffering from pain throughout the course of the illness and especially at the end of life,” they wrote.

Among 104 children enrolled in the study with 920 completed symptom assessments over a 9-month follow-up, pain was most frequently reported (48%), followed by fatigue (46%), drowsiness (39%), and nausea (35%). Emotional distress was prevalent as well: irritability (37%), sleep disturbance (29%), nervousness (25%), sadness (24%), and worrying (24%). High distress was indicated for most scores.

During the last 12 weeks of life, prevalence of symptoms and levels of high distress worsened. The prevalence of pain increased to 62%; 58% with high distress. Fatigue rose to 49%, and drowsiness to 50%.

To establish patient reported outcomes (PROs) for children, PediQUEST collects child-reported symptoms (or parent-reported when necessary) and HRQoL data via computer and generates feedback reports and email alerts.

Higher symptom scores were associated with several factors, including being female, having a brain tumor, having disease progression within the previous 10 days, and receiving moderate- to high-intensity cancer treatment within the previous 10 days.

“Implications from these findings are not necessarily to decrease the amount or intensity of cancer-directed therapy offered but rather to increase efforts to ameliorate symptom distress,” the investigators wrote.

Toxicities associated with immunotherapies cover a wide range from capillary leakage with cytokine therapies, to damaging cross reactivities of cell therapies, to autoinflammatory reactions observed with immune checkpoint inhibitors, according to a review published online April 27 in the Journal of Clinical Oncology.

Most toxicities involve hyperactivated T-cell responses directed against healthy tissue. In general, cytokine therapy generates diffuse, nonspecific T-cell reactivity, while vaccines, adoptive cell therapy, and checkpoint protein inhibitors generate specific T-cell responses directed to normal tissue that can cause organ damage. Dr. Jeffrey S. Weber, director of the Donald A. Adam Comprehensive Melanoma Research Center at the Moffitt Cancer Center and Research Institute, Tampa, and his colleagues summarized the toxicities specific to immunotherapies and emphasized the importance of oncology practitioners understanding the spectrum of adverse events and treatment options available (J. Clin. Oncol. 2015 Apr. 27 [doi:10.1200/JCO.2014.60.0379]).

Minimal toxicity has been observed with cancer vaccines, possibly because the tumor-associated targets are overexpressed in cancer cells but are found at low or undetectable levels in normal cells. Human epidermal growth factor receptor 2 (HER2), p53, and survivin are the most common vaccine targets. Sipuleucel-T, the one currently approved vaccine, has a favorable toxicity profile, with transient chills, fatigue, and fever the most common adverse events (AEs).

By contrast, cytokines are associated with frequent and severe AEs, which has dampened enthusiasm for the treatment. The FDA approved recombinant human interferon-alpha (IFN) for the treatment of hairy cell leukemia and high-risk melanoma, and interleukin-2 was approved for advanced renal cell carcinoma and melanoma.

IFN treatment results in constitutional symptoms of fever and fatigue in more than 80% of recipients, as well as headache and myalgia. Nonsteroidal anti-inflammatory drugs are helpful. Up to one-third of patients have diarrhea and two thirds have nausea and anorexia. Neuropsychiatric issues are observed, such as confusion in about 10% of patients, depression in up to 45%, and psychosis in less than 1%. Prophylactic antidepressants may reduce the risk of depression in those with a history of depression, but careful monitoring of all patients is suggested.

Thrombocytopenia and leukopenia are observed in up to 10% of patients. Hyperthyroidism or hypothyroidism occurs in 10%-15% of patients. Sarcoid is rare, but may be confused with disease progression in patients with melanoma or lymphoma. IFN may cause autoimmune events, but some investigators noted that this may be associated with improved treatment outcomes.

IL-2 treatment leads to increased vascular permeability and fluid retention, including pleural effusions and pulmonary edema, hypotension, and prerenal azotemia. Thrombocytopenia, anemia, coagulopathy, or neutrophil chemotaxis impairment leading to catheter infections may occur. Neurotoxicity associated with IL-2 can be subtle, such as lethargy and irritability, or severe as in florid psychosis.

Mediators of IL-2 toxicity include nitric oxide, IL-1, tumor necrosis factor–alpha, and IFN-gamma, but inhibitors of these toxic factors have been unsuccessful.

Adoptive T-cell therapies have effectively treated patients with certain metastatic cancers, including melanoma, metastatic cervical cancer, and B-cell malignancies. Preparative chemotherapy for lymphodepletion leaves patients at risk for sepsis and bleeding before hematopoietic recovery, which is the dominant cause of a 1%-2% rate of mortality.

Cytokine release syndrome resembles sepsis and is also seen with high-dose IL-2. With supportive care, even severe renal failure, coma, and respiratory failure are completely reversed usually. IL-6 was identified as a mediator in one case involving B-cell malignancy, and an IL-6 receptor-blocking antibody showed apparent benefit.

Autoimmunity induced by the T cells may occur, the consequences of which depend on the level and distribution of the normal tissue expression of the target.

Standard interventions for life-threatening adverse responses to T-cell therapy include high-dose corticosteroids and alemtuzumab (anti-CD52 antibody) to suppress lymphocytes, a treatment which may circumvent antitumor effects as well.

Since 2011, checkpoint inhibitors ipilimumab (anti-CTLA-4), pembrolizumab, and nivolumab (both anti-PD-1) have been approved by the Food and Drug Administration and are commonly used for patients with melanoma and other cancers. Autoimmune reactions are common, and all patients are recommended to have thyroid function studies, complete blood counts, and liver function and metabolic panels at each treatment and regular intervals for 6 months following treatment.

Ipilimumab toxicities are dose related, while toxicities associated with PD-1 blockade do not appear to be dose related. The most common drug related AEs of any grade were fatigue, pruritus, and rash.

Toxicities associated with PD-1 antibodies vary depending on the histology treated. For severe colitis caused by ipilimumab or PD-1 antibodies, high doses of corticosteroids are required, and infliximab administered in patients whose colitis fails to resolve within three days.

The onset of immune-related AEs follows a predictable pattern, with skin-related toxicities occurring first, followed by colitis, then hepatitis and endocrinopathies observed between weeks 12 and 24.

“The key to successful management of checkpoint protein antibody toxicities is early diagnosis, high suspicion, excellent patient-provider communication, and rapid and aggressive use of corticosteroids and other immune suppressants for immune-related AEs,” Dr. Weber and his associates wrote.

Dr. Weber and his associates reported receiving research funding from or having consulting or advisory roles with several industry sources.

Toxicities associated with immunotherapies cover a wide range from capillary leakage with cytokine therapies, to damaging cross reactivities of cell therapies, to autoinflammatory reactions observed with immune checkpoint inhibitors, according to a review published online April 27 in the Journal of Clinical Oncology.

Most toxicities involve hyperactivated T-cell responses directed against healthy tissue. In general, cytokine therapy generates diffuse, nonspecific T-cell reactivity, while vaccines, adoptive cell therapy, and checkpoint protein inhibitors generate specific T-cell responses directed to normal tissue that can cause organ damage. Dr. Jeffrey S. Weber, director of the Donald A. Adam Comprehensive Melanoma Research Center at the Moffitt Cancer Center and Research Institute, Tampa, and his colleagues summarized the toxicities specific to immunotherapies and emphasized the importance of oncology practitioners understanding the spectrum of adverse events and treatment options available (J. Clin. Oncol. 2015 Apr. 27 [doi:10.1200/JCO.2014.60.0379]).

Minimal toxicity has been observed with cancer vaccines, possibly because the tumor-associated targets are overexpressed in cancer cells but are found at low or undetectable levels in normal cells. Human epidermal growth factor receptor 2 (HER2), p53, and survivin are the most common vaccine targets. Sipuleucel-T, the one currently approved vaccine, has a favorable toxicity profile, with transient chills, fatigue, and fever the most common adverse events (AEs).

By contrast, cytokines are associated with frequent and severe AEs, which has dampened enthusiasm for the treatment. The FDA approved recombinant human interferon-alpha (IFN) for the treatment of hairy cell leukemia and high-risk melanoma, and interleukin-2 was approved for advanced renal cell carcinoma and melanoma.

IFN treatment results in constitutional symptoms of fever and fatigue in more than 80% of recipients, as well as headache and myalgia. Nonsteroidal anti-inflammatory drugs are helpful. Up to one-third of patients have diarrhea and two thirds have nausea and anorexia. Neuropsychiatric issues are observed, such as confusion in about 10% of patients, depression in up to 45%, and psychosis in less than 1%. Prophylactic antidepressants may reduce the risk of depression in those with a history of depression, but careful monitoring of all patients is suggested.

Thrombocytopenia and leukopenia are observed in up to 10% of patients. Hyperthyroidism or hypothyroidism occurs in 10%-15% of patients. Sarcoid is rare, but may be confused with disease progression in patients with melanoma or lymphoma. IFN may cause autoimmune events, but some investigators noted that this may be associated with improved treatment outcomes.

IL-2 treatment leads to increased vascular permeability and fluid retention, including pleural effusions and pulmonary edema, hypotension, and prerenal azotemia. Thrombocytopenia, anemia, coagulopathy, or neutrophil chemotaxis impairment leading to catheter infections may occur. Neurotoxicity associated with IL-2 can be subtle, such as lethargy and irritability, or severe as in florid psychosis.

Mediators of IL-2 toxicity include nitric oxide, IL-1, tumor necrosis factor–alpha, and IFN-gamma, but inhibitors of these toxic factors have been unsuccessful.

Adoptive T-cell therapies have effectively treated patients with certain metastatic cancers, including melanoma, metastatic cervical cancer, and B-cell malignancies. Preparative chemotherapy for lymphodepletion leaves patients at risk for sepsis and bleeding before hematopoietic recovery, which is the dominant cause of a 1%-2% rate of mortality.

Cytokine release syndrome resembles sepsis and is also seen with high-dose IL-2. With supportive care, even severe renal failure, coma, and respiratory failure are completely reversed usually. IL-6 was identified as a mediator in one case involving B-cell malignancy, and an IL-6 receptor-blocking antibody showed apparent benefit.

Autoimmunity induced by the T cells may occur, the consequences of which depend on the level and distribution of the normal tissue expression of the target.

Standard interventions for life-threatening adverse responses to T-cell therapy include high-dose corticosteroids and alemtuzumab (anti-CD52 antibody) to suppress lymphocytes, a treatment which may circumvent antitumor effects as well.

Since 2011, checkpoint inhibitors ipilimumab (anti-CTLA-4), pembrolizumab, and nivolumab (both anti-PD-1) have been approved by the Food and Drug Administration and are commonly used for patients with melanoma and other cancers. Autoimmune reactions are common, and all patients are recommended to have thyroid function studies, complete blood counts, and liver function and metabolic panels at each treatment and regular intervals for 6 months following treatment.

Ipilimumab toxicities are dose related, while toxicities associated with PD-1 blockade do not appear to be dose related. The most common drug related AEs of any grade were fatigue, pruritus, and rash.

Toxicities associated with PD-1 antibodies vary depending on the histology treated. For severe colitis caused by ipilimumab or PD-1 antibodies, high doses of corticosteroids are required, and infliximab administered in patients whose colitis fails to resolve within three days.

The onset of immune-related AEs follows a predictable pattern, with skin-related toxicities occurring first, followed by colitis, then hepatitis and endocrinopathies observed between weeks 12 and 24.

“The key to successful management of checkpoint protein antibody toxicities is early diagnosis, high suspicion, excellent patient-provider communication, and rapid and aggressive use of corticosteroids and other immune suppressants for immune-related AEs,” Dr. Weber and his associates wrote.

Dr. Weber and his associates reported receiving research funding from or having consulting or advisory roles with several industry sources.

Toxicities associated with immunotherapies cover a wide range from capillary leakage with cytokine therapies, to damaging cross reactivities of cell therapies, to autoinflammatory reactions observed with immune checkpoint inhibitors, according to a review published online April 27 in the Journal of Clinical Oncology.

Most toxicities involve hyperactivated T-cell responses directed against healthy tissue. In general, cytokine therapy generates diffuse, nonspecific T-cell reactivity, while vaccines, adoptive cell therapy, and checkpoint protein inhibitors generate specific T-cell responses directed to normal tissue that can cause organ damage. Dr. Jeffrey S. Weber, director of the Donald A. Adam Comprehensive Melanoma Research Center at the Moffitt Cancer Center and Research Institute, Tampa, and his colleagues summarized the toxicities specific to immunotherapies and emphasized the importance of oncology practitioners understanding the spectrum of adverse events and treatment options available (J. Clin. Oncol. 2015 Apr. 27 [doi:10.1200/JCO.2014.60.0379]).

Minimal toxicity has been observed with cancer vaccines, possibly because the tumor-associated targets are overexpressed in cancer cells but are found at low or undetectable levels in normal cells. Human epidermal growth factor receptor 2 (HER2), p53, and survivin are the most common vaccine targets. Sipuleucel-T, the one currently approved vaccine, has a favorable toxicity profile, with transient chills, fatigue, and fever the most common adverse events (AEs).

By contrast, cytokines are associated with frequent and severe AEs, which has dampened enthusiasm for the treatment. The FDA approved recombinant human interferon-alpha (IFN) for the treatment of hairy cell leukemia and high-risk melanoma, and interleukin-2 was approved for advanced renal cell carcinoma and melanoma.

IFN treatment results in constitutional symptoms of fever and fatigue in more than 80% of recipients, as well as headache and myalgia. Nonsteroidal anti-inflammatory drugs are helpful. Up to one-third of patients have diarrhea and two thirds have nausea and anorexia. Neuropsychiatric issues are observed, such as confusion in about 10% of patients, depression in up to 45%, and psychosis in less than 1%. Prophylactic antidepressants may reduce the risk of depression in those with a history of depression, but careful monitoring of all patients is suggested.

Thrombocytopenia and leukopenia are observed in up to 10% of patients. Hyperthyroidism or hypothyroidism occurs in 10%-15% of patients. Sarcoid is rare, but may be confused with disease progression in patients with melanoma or lymphoma. IFN may cause autoimmune events, but some investigators noted that this may be associated with improved treatment outcomes.

IL-2 treatment leads to increased vascular permeability and fluid retention, including pleural effusions and pulmonary edema, hypotension, and prerenal azotemia. Thrombocytopenia, anemia, coagulopathy, or neutrophil chemotaxis impairment leading to catheter infections may occur. Neurotoxicity associated with IL-2 can be subtle, such as lethargy and irritability, or severe as in florid psychosis.

Mediators of IL-2 toxicity include nitric oxide, IL-1, tumor necrosis factor–alpha, and IFN-gamma, but inhibitors of these toxic factors have been unsuccessful.

Adoptive T-cell therapies have effectively treated patients with certain metastatic cancers, including melanoma, metastatic cervical cancer, and B-cell malignancies. Preparative chemotherapy for lymphodepletion leaves patients at risk for sepsis and bleeding before hematopoietic recovery, which is the dominant cause of a 1%-2% rate of mortality.

Cytokine release syndrome resembles sepsis and is also seen with high-dose IL-2. With supportive care, even severe renal failure, coma, and respiratory failure are completely reversed usually. IL-6 was identified as a mediator in one case involving B-cell malignancy, and an IL-6 receptor-blocking antibody showed apparent benefit.

Autoimmunity induced by the T cells may occur, the consequences of which depend on the level and distribution of the normal tissue expression of the target.

Standard interventions for life-threatening adverse responses to T-cell therapy include high-dose corticosteroids and alemtuzumab (anti-CD52 antibody) to suppress lymphocytes, a treatment which may circumvent antitumor effects as well.

Since 2011, checkpoint inhibitors ipilimumab (anti-CTLA-4), pembrolizumab, and nivolumab (both anti-PD-1) have been approved by the Food and Drug Administration and are commonly used for patients with melanoma and other cancers. Autoimmune reactions are common, and all patients are recommended to have thyroid function studies, complete blood counts, and liver function and metabolic panels at each treatment and regular intervals for 6 months following treatment.

Ipilimumab toxicities are dose related, while toxicities associated with PD-1 blockade do not appear to be dose related. The most common drug related AEs of any grade were fatigue, pruritus, and rash.

Toxicities associated with PD-1 antibodies vary depending on the histology treated. For severe colitis caused by ipilimumab or PD-1 antibodies, high doses of corticosteroids are required, and infliximab administered in patients whose colitis fails to resolve within three days.

The onset of immune-related AEs follows a predictable pattern, with skin-related toxicities occurring first, followed by colitis, then hepatitis and endocrinopathies observed between weeks 12 and 24.

“The key to successful management of checkpoint protein antibody toxicities is early diagnosis, high suspicion, excellent patient-provider communication, and rapid and aggressive use of corticosteroids and other immune suppressants for immune-related AEs,” Dr. Weber and his associates wrote.

Dr. Weber and his associates reported receiving research funding from or having consulting or advisory roles with several industry sources.

Compared with usual care, a moderate- to high-intensity exercise intervention had beneficial effects on chemotherapy completion rates, symptom burden, and return-to-work rates among women with breast cancer who were undergoing adjuvant chemotherapy, according to a study published online April 27 in the Journal of Clinical Oncology.

For the multicenter Physical Exercise During Adjuvant Chemotherapy Effectiveness Study (PACES), 230 women (mean age 51 years) with breast cancer who were undergoing adjuvant chemotherapy were randomized to participate in a high- to moderate-intensity exercise program supervised by physical therapists (n = 76), a low-intensity home-based program (n = 77), or the usual care group (n = 77).

©Luka8au/thinkstockphotos.com

Dose adjustments in the chemotherapy regimen were less frequent in the moderate- to high-intensity exercise group (12%) than in the usual care or low-intensity groups (both 34%, P = .002). Patients in the exercise interventions were more likely to return to work by the 6-month follow up than those with usual care, wrote Ms. Hanna van Waart, a doctoral candidate at the Netherlands Cancer Institute, Amsterdam, and colleagues (J. Clin. Oncol. 2015 Apr. 27 [doi:10.1200/JCO.2014.59.1081]).

“This not only has financial implications, but also carries meaning in terms of quality of life and a sense of return to normalcy,” they wrote.

At completion of chemotherapy, patients from both activity groups reported significantly better physical functioning, less nausea and vomiting, and less pain than did those in the usual care group.

Compared with usual care, a moderate- to high-intensity exercise intervention had beneficial effects on chemotherapy completion rates, symptom burden, and return-to-work rates among women with breast cancer who were undergoing adjuvant chemotherapy, according to a study published online April 27 in the Journal of Clinical Oncology.

For the multicenter Physical Exercise During Adjuvant Chemotherapy Effectiveness Study (PACES), 230 women (mean age 51 years) with breast cancer who were undergoing adjuvant chemotherapy were randomized to participate in a high- to moderate-intensity exercise program supervised by physical therapists (n = 76), a low-intensity home-based program (n = 77), or the usual care group (n = 77).

©Luka8au/thinkstockphotos.com

Dose adjustments in the chemotherapy regimen were less frequent in the moderate- to high-intensity exercise group (12%) than in the usual care or low-intensity groups (both 34%, P = .002). Patients in the exercise interventions were more likely to return to work by the 6-month follow up than those with usual care, wrote Ms. Hanna van Waart, a doctoral candidate at the Netherlands Cancer Institute, Amsterdam, and colleagues (J. Clin. Oncol. 2015 Apr. 27 [doi:10.1200/JCO.2014.59.1081]).

“This not only has financial implications, but also carries meaning in terms of quality of life and a sense of return to normalcy,” they wrote.

At completion of chemotherapy, patients from both activity groups reported significantly better physical functioning, less nausea and vomiting, and less pain than did those in the usual care group.

Compared with usual care, a moderate- to high-intensity exercise intervention had beneficial effects on chemotherapy completion rates, symptom burden, and return-to-work rates among women with breast cancer who were undergoing adjuvant chemotherapy, according to a study published online April 27 in the Journal of Clinical Oncology.

For the multicenter Physical Exercise During Adjuvant Chemotherapy Effectiveness Study (PACES), 230 women (mean age 51 years) with breast cancer who were undergoing adjuvant chemotherapy were randomized to participate in a high- to moderate-intensity exercise program supervised by physical therapists (n = 76), a low-intensity home-based program (n = 77), or the usual care group (n = 77).

©Luka8au/thinkstockphotos.com

Dose adjustments in the chemotherapy regimen were less frequent in the moderate- to high-intensity exercise group (12%) than in the usual care or low-intensity groups (both 34%, P = .002). Patients in the exercise interventions were more likely to return to work by the 6-month follow up than those with usual care, wrote Ms. Hanna van Waart, a doctoral candidate at the Netherlands Cancer Institute, Amsterdam, and colleagues (J. Clin. Oncol. 2015 Apr. 27 [doi:10.1200/JCO.2014.59.1081]).

“This not only has financial implications, but also carries meaning in terms of quality of life and a sense of return to normalcy,” they wrote.

At completion of chemotherapy, patients from both activity groups reported significantly better physical functioning, less nausea and vomiting, and less pain than did those in the usual care group.

Sarcoidosis is a multisystem granulomatous disease that affects 10-40 people per 100,000 in the United States and Europe, with an increased prevalence among blacks compared with whites.¹ The clinical presentation of sarcoidosis is variable. Sarcoidosis frequently involves the lungs and can have numerous extrapulmonary manifestations including skin, joint, cardiac, and eye lesions. We present a rare case of sarcoidosis with concurrent third-degree heart block and warm autoimmune hemolytic anemia and discuss possible mechanisms behind this presentation.
 

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

Sarcoidosis is a multisystem granulomatous disease that affects 10-40 people per 100,000 in the United States and Europe, with an increased prevalence among blacks compared with whites.¹ The clinical presentation of sarcoidosis is variable. Sarcoidosis frequently involves the lungs and can have numerous extrapulmonary manifestations including skin, joint, cardiac, and eye lesions. We present a rare case of sarcoidosis with concurrent third-degree heart block and warm autoimmune hemolytic anemia and discuss possible mechanisms behind this presentation.
 

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

Sarcoidosis is a multisystem granulomatous disease that affects 10-40 people per 100,000 in the United States and Europe, with an increased prevalence among blacks compared with whites.¹ The clinical presentation of sarcoidosis is variable. Sarcoidosis frequently involves the lungs and can have numerous extrapulmonary manifestations including skin, joint, cardiac, and eye lesions. We present a rare case of sarcoidosis with concurrent third-degree heart block and warm autoimmune hemolytic anemia and discuss possible mechanisms behind this presentation.
 

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

Background Treatment-related symptoms and decreased health-related quality of life (HRQoL) frequently occur during chemotherapy for breast cancer. Although research findings suggest that yoga can reduce symptoms and improve HRQoL after treatment, potential benefits of yoga during chemotherapy have received minimal attention.

Objective To estimate accrual, adherence, study retention, and preliminary efficacy of a yoga intervention compared with an active control group for breast cancer patients during chemotherapy.

Methods Women with stage I-III breast cancer were recruited from 3 community cancer clinics and randomized to 10 weeks of gentle yoga or wellness education. Depressive symptoms, fatigue, sleep, and HRQoL were assessed at baseline, mid-intervention (Week 5), and after intervention (Week 10).

Results 40 women aged 29-83 years (median, 48 years; 88% white) were randomized to yoga (n = 22) or wellness education (n = 18). The groups did not differ significantly on baseline characteristics, adherence, or study retention. Participant feedback was positive and comparable between groups. Meaningful within-group differences were identified for sleep adequacy and quantity in yoga participants and for somnolence in wellness-education participants.

Limitations Small sample size and lack of a usual-care control group.

Conclusions This study established feasibility of a community-based randomized trial of yoga and an active comparison group for women undergoing chemotherapy for breast cancer. Preliminary efficacy estimates suggest that yoga improves sleep adequacy. Symptom severity and interference remained stable during chemotherapy for the yoga group and showed a trend toward increasing in the control group. The study highlighted obstacles to multisite yoga research during cancer treatment.

Funding/sponsorship National Cancer Institute (3U10 CA081851, PI: Shaw; R25 CA122061, PI: Avis); Translational Science Institute, Wake Forest School of Medicine

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

Background Treatment-related symptoms and decreased health-related quality of life (HRQoL) frequently occur during chemotherapy for breast cancer. Although research findings suggest that yoga can reduce symptoms and improve HRQoL after treatment, potential benefits of yoga during chemotherapy have received minimal attention.

Objective To estimate accrual, adherence, study retention, and preliminary efficacy of a yoga intervention compared with an active control group for breast cancer patients during chemotherapy.

Methods Women with stage I-III breast cancer were recruited from 3 community cancer clinics and randomized to 10 weeks of gentle yoga or wellness education. Depressive symptoms, fatigue, sleep, and HRQoL were assessed at baseline, mid-intervention (Week 5), and after intervention (Week 10).

Results 40 women aged 29-83 years (median, 48 years; 88% white) were randomized to yoga (n = 22) or wellness education (n = 18). The groups did not differ significantly on baseline characteristics, adherence, or study retention. Participant feedback was positive and comparable between groups. Meaningful within-group differences were identified for sleep adequacy and quantity in yoga participants and for somnolence in wellness-education participants.

Limitations Small sample size and lack of a usual-care control group.

Conclusions This study established feasibility of a community-based randomized trial of yoga and an active comparison group for women undergoing chemotherapy for breast cancer. Preliminary efficacy estimates suggest that yoga improves sleep adequacy. Symptom severity and interference remained stable during chemotherapy for the yoga group and showed a trend toward increasing in the control group. The study highlighted obstacles to multisite yoga research during cancer treatment.

Funding/sponsorship National Cancer Institute (3U10 CA081851, PI: Shaw; R25 CA122061, PI: Avis); Translational Science Institute, Wake Forest School of Medicine

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

Background Treatment-related symptoms and decreased health-related quality of life (HRQoL) frequently occur during chemotherapy for breast cancer. Although research findings suggest that yoga can reduce symptoms and improve HRQoL after treatment, potential benefits of yoga during chemotherapy have received minimal attention.

Objective To estimate accrual, adherence, study retention, and preliminary efficacy of a yoga intervention compared with an active control group for breast cancer patients during chemotherapy.

Methods Women with stage I-III breast cancer were recruited from 3 community cancer clinics and randomized to 10 weeks of gentle yoga or wellness education. Depressive symptoms, fatigue, sleep, and HRQoL were assessed at baseline, mid-intervention (Week 5), and after intervention (Week 10).

Results 40 women aged 29-83 years (median, 48 years; 88% white) were randomized to yoga (n = 22) or wellness education (n = 18). The groups did not differ significantly on baseline characteristics, adherence, or study retention. Participant feedback was positive and comparable between groups. Meaningful within-group differences were identified for sleep adequacy and quantity in yoga participants and for somnolence in wellness-education participants.

Limitations Small sample size and lack of a usual-care control group.

Conclusions This study established feasibility of a community-based randomized trial of yoga and an active comparison group for women undergoing chemotherapy for breast cancer. Preliminary efficacy estimates suggest that yoga improves sleep adequacy. Symptom severity and interference remained stable during chemotherapy for the yoga group and showed a trend toward increasing in the control group. The study highlighted obstacles to multisite yoga research during cancer treatment.

Funding/sponsorship National Cancer Institute (3U10 CA081851, PI: Shaw; R25 CA122061, PI: Avis); Translational Science Institute, Wake Forest School of Medicine

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