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ASCO Update Keeps Breast Cancer Survivor Guidelines Intact
The American Society of Clinical Oncology has issued updated recommendations for the follow-up care of breast cancer survivors, but made no changes from guidelines released in 2006.
The current guidelines include recommendations for all oncologists, primary care providers, and nurses who treat asymptomatic breast cancer survivors. They emphasize physical exams, patient history, and mammography, but discourage routine blood tests, biomarker studies, and other imaging in the absence of symptoms.
An American Society of Clinical Oncology (ASCO) panel reviewed the literature for studies that specifically focused on patient management for patients who had finished their primary therapy to cure breast cancer. The updated recommendations were published online Nov. 5 in the Journal of Clinical Oncology (doi: 10.1200/JCO.2012.45.9859).
Dr. James L. Khatcheressian, from the Virginia Cancer Institute in Richmond, and his associates on the ASCO Clinical Practice Guidelines Committee searched Medline and the Cochrane Library for all systematic reviews, clinical practice guidelines, and randomized controlled trials published between March 2006 and March 2012.
The committee primarily sought outcomes data on "disease-free survival, overall survival, health-related quality of life, reduced toxicity, and cost effectiveness." Its analysis of nine systematic reviews (including three meta-analyses) and five randomized controlled trials led the committee to conclude that no modifications to the clinical practice guidelines from 6 years ago were necessary.
The recommendations are as follows:
• Providers should give women a physical exam and history every 3-6 months for the first 3 years after they receive primary therapy. Then, a history and physical exam should be conducted every 6-12 months for the next 2 years, followed by annual ones.
• Women who had breast-conserving surgery should receive their first mammogram at least 6 months after completing radiation therapy, followed by a mammogram every 6-12 months. Once they achieve "stability of mammographic findings" after completing locoregional therapy, mammography can be done yearly.
• Women should be advised to do monthly breast self-exams and be educated about symptoms indicating possible cancer recurrence, such as lumps, bone pain, chest pain, dyspnea, abdominal pain, or persistent headaches.
• Those who meet the criteria for high risk of family breast cancer should be referred to genetic counseling. These criteria include "Ashkenazi Jewish heritage; history of ovarian cancer at any age in the patient or any first- or second-degree relatives; any first-degree relative with a history of breast cancer diagnosed before the age of 50 years; two or more first- or second-degree relatives diagnosed with breast cancer at any age; patient or relative with diagnosis of bilateral breast cancer; and history of breast cancer in a male relative."
• Women should also receive regular annual gynecologic care, except those who had a total hysterectomy or oophorectomy, who can have less frequent checkups. Women who take tamoxifen should be instructed to tell their doctor about any vaginal bleeding since they are at a higher risk for endometrial cancer.
Although the committee recommends continuous care by a doctor with experience in breast exams and cancer survivors, they note that "follow-up by a primary care provider seems to lead to the same health outcomes as specialist follow-up, with good patient satisfaction." Women with early-stage breast cancer wishing to be treated by their primary care provider may be transferred a year after diagnosis.
The clinical practice guidelines note that routine blood tests (CBC testing and chemistry panels), breast cancer tumor marker testing, and imaging studies besides mammograms are not recommended if patients have no symptoms. Chest x-rays, bone scans, liver ultrasounds, CT scans, 18F-deoxyglucose (FDG)–PET scans, and breast MRIs also are not recommended for standard follow-up care.
However, the committee stated that the practice guidelines are voluntary, and "do not account for individual variation among patients and may not reflect the most recent evidence." Therefore, management of each patient should depend on her case history and circumstances, and rely on the professional judgment of her doctor.
While the committee concluded that no new evidence warrants changes to the guidelines, it said that research is needed (in particular, randomized controlled trials) on comparative effectiveness of different surveillance strategies and duration of follow-up. It also called for more research into tumor marker testing and identification of patient subsets that would benefit from various models of care.
The article received no external funding. Lead author Dr. N. Lynn Henry has been paid for consultancy or advisory work for GE Healthcare. No other disclosures were reported.
The American Society of Clinical Oncology has issued updated recommendations for the follow-up care of breast cancer survivors, but made no changes from guidelines released in 2006.
The current guidelines include recommendations for all oncologists, primary care providers, and nurses who treat asymptomatic breast cancer survivors. They emphasize physical exams, patient history, and mammography, but discourage routine blood tests, biomarker studies, and other imaging in the absence of symptoms.
An American Society of Clinical Oncology (ASCO) panel reviewed the literature for studies that specifically focused on patient management for patients who had finished their primary therapy to cure breast cancer. The updated recommendations were published online Nov. 5 in the Journal of Clinical Oncology (doi: 10.1200/JCO.2012.45.9859).
Dr. James L. Khatcheressian, from the Virginia Cancer Institute in Richmond, and his associates on the ASCO Clinical Practice Guidelines Committee searched Medline and the Cochrane Library for all systematic reviews, clinical practice guidelines, and randomized controlled trials published between March 2006 and March 2012.
The committee primarily sought outcomes data on "disease-free survival, overall survival, health-related quality of life, reduced toxicity, and cost effectiveness." Its analysis of nine systematic reviews (including three meta-analyses) and five randomized controlled trials led the committee to conclude that no modifications to the clinical practice guidelines from 6 years ago were necessary.
The recommendations are as follows:
• Providers should give women a physical exam and history every 3-6 months for the first 3 years after they receive primary therapy. Then, a history and physical exam should be conducted every 6-12 months for the next 2 years, followed by annual ones.
• Women who had breast-conserving surgery should receive their first mammogram at least 6 months after completing radiation therapy, followed by a mammogram every 6-12 months. Once they achieve "stability of mammographic findings" after completing locoregional therapy, mammography can be done yearly.
• Women should be advised to do monthly breast self-exams and be educated about symptoms indicating possible cancer recurrence, such as lumps, bone pain, chest pain, dyspnea, abdominal pain, or persistent headaches.
• Those who meet the criteria for high risk of family breast cancer should be referred to genetic counseling. These criteria include "Ashkenazi Jewish heritage; history of ovarian cancer at any age in the patient or any first- or second-degree relatives; any first-degree relative with a history of breast cancer diagnosed before the age of 50 years; two or more first- or second-degree relatives diagnosed with breast cancer at any age; patient or relative with diagnosis of bilateral breast cancer; and history of breast cancer in a male relative."
• Women should also receive regular annual gynecologic care, except those who had a total hysterectomy or oophorectomy, who can have less frequent checkups. Women who take tamoxifen should be instructed to tell their doctor about any vaginal bleeding since they are at a higher risk for endometrial cancer.
Although the committee recommends continuous care by a doctor with experience in breast exams and cancer survivors, they note that "follow-up by a primary care provider seems to lead to the same health outcomes as specialist follow-up, with good patient satisfaction." Women with early-stage breast cancer wishing to be treated by their primary care provider may be transferred a year after diagnosis.
The clinical practice guidelines note that routine blood tests (CBC testing and chemistry panels), breast cancer tumor marker testing, and imaging studies besides mammograms are not recommended if patients have no symptoms. Chest x-rays, bone scans, liver ultrasounds, CT scans, 18F-deoxyglucose (FDG)–PET scans, and breast MRIs also are not recommended for standard follow-up care.
However, the committee stated that the practice guidelines are voluntary, and "do not account for individual variation among patients and may not reflect the most recent evidence." Therefore, management of each patient should depend on her case history and circumstances, and rely on the professional judgment of her doctor.
While the committee concluded that no new evidence warrants changes to the guidelines, it said that research is needed (in particular, randomized controlled trials) on comparative effectiveness of different surveillance strategies and duration of follow-up. It also called for more research into tumor marker testing and identification of patient subsets that would benefit from various models of care.
The article received no external funding. Lead author Dr. N. Lynn Henry has been paid for consultancy or advisory work for GE Healthcare. No other disclosures were reported.
The American Society of Clinical Oncology has issued updated recommendations for the follow-up care of breast cancer survivors, but made no changes from guidelines released in 2006.
The current guidelines include recommendations for all oncologists, primary care providers, and nurses who treat asymptomatic breast cancer survivors. They emphasize physical exams, patient history, and mammography, but discourage routine blood tests, biomarker studies, and other imaging in the absence of symptoms.
An American Society of Clinical Oncology (ASCO) panel reviewed the literature for studies that specifically focused on patient management for patients who had finished their primary therapy to cure breast cancer. The updated recommendations were published online Nov. 5 in the Journal of Clinical Oncology (doi: 10.1200/JCO.2012.45.9859).
Dr. James L. Khatcheressian, from the Virginia Cancer Institute in Richmond, and his associates on the ASCO Clinical Practice Guidelines Committee searched Medline and the Cochrane Library for all systematic reviews, clinical practice guidelines, and randomized controlled trials published between March 2006 and March 2012.
The committee primarily sought outcomes data on "disease-free survival, overall survival, health-related quality of life, reduced toxicity, and cost effectiveness." Its analysis of nine systematic reviews (including three meta-analyses) and five randomized controlled trials led the committee to conclude that no modifications to the clinical practice guidelines from 6 years ago were necessary.
The recommendations are as follows:
• Providers should give women a physical exam and history every 3-6 months for the first 3 years after they receive primary therapy. Then, a history and physical exam should be conducted every 6-12 months for the next 2 years, followed by annual ones.
• Women who had breast-conserving surgery should receive their first mammogram at least 6 months after completing radiation therapy, followed by a mammogram every 6-12 months. Once they achieve "stability of mammographic findings" after completing locoregional therapy, mammography can be done yearly.
• Women should be advised to do monthly breast self-exams and be educated about symptoms indicating possible cancer recurrence, such as lumps, bone pain, chest pain, dyspnea, abdominal pain, or persistent headaches.
• Those who meet the criteria for high risk of family breast cancer should be referred to genetic counseling. These criteria include "Ashkenazi Jewish heritage; history of ovarian cancer at any age in the patient or any first- or second-degree relatives; any first-degree relative with a history of breast cancer diagnosed before the age of 50 years; two or more first- or second-degree relatives diagnosed with breast cancer at any age; patient or relative with diagnosis of bilateral breast cancer; and history of breast cancer in a male relative."
• Women should also receive regular annual gynecologic care, except those who had a total hysterectomy or oophorectomy, who can have less frequent checkups. Women who take tamoxifen should be instructed to tell their doctor about any vaginal bleeding since they are at a higher risk for endometrial cancer.
Although the committee recommends continuous care by a doctor with experience in breast exams and cancer survivors, they note that "follow-up by a primary care provider seems to lead to the same health outcomes as specialist follow-up, with good patient satisfaction." Women with early-stage breast cancer wishing to be treated by their primary care provider may be transferred a year after diagnosis.
The clinical practice guidelines note that routine blood tests (CBC testing and chemistry panels), breast cancer tumor marker testing, and imaging studies besides mammograms are not recommended if patients have no symptoms. Chest x-rays, bone scans, liver ultrasounds, CT scans, 18F-deoxyglucose (FDG)–PET scans, and breast MRIs also are not recommended for standard follow-up care.
However, the committee stated that the practice guidelines are voluntary, and "do not account for individual variation among patients and may not reflect the most recent evidence." Therefore, management of each patient should depend on her case history and circumstances, and rely on the professional judgment of her doctor.
While the committee concluded that no new evidence warrants changes to the guidelines, it said that research is needed (in particular, randomized controlled trials) on comparative effectiveness of different surveillance strategies and duration of follow-up. It also called for more research into tumor marker testing and identification of patient subsets that would benefit from various models of care.
The article received no external funding. Lead author Dr. N. Lynn Henry has been paid for consultancy or advisory work for GE Healthcare. No other disclosures were reported.
FROM THE JOURNAL OF CLINICAL ONCOLOGY
Major Finding: Updated recommendations from the American Society of Clinical Oncology’s guidelines on follow-up care for breast cancer survivors remain unchanged from 2006 guidelines, and include regular physical exams and mammography.
Data Source: The updated review of the literature consisted of 14 studies, including 9 systematic reviews and 5 randomized controlled trials.
Disclosures: The article received no external funding. Lead author Dr. N. Lynn Henry has been paid for consultancy or advisory work for GE Healthcare. No other disclosures were reported.
Age Ups Risk of Other Cancers in Breast Cancer Survivors
MANCHESTER, ENGLAND – Older women who are breast cancer survivors have a greater risk of developing additional primary cancers in the long term than those under 65 years of age, according to an analysis of data on more than 100,000 survivors in the United States.
Women aged 70-79 years appear to have the highest risk of developing a multiple primary malignancy (MPM), with a crude 10-year incidence of 17.8/10,000 person-years. In comparisons, the rate of risk for survivors younger than 65 was 11.7, increasing to 16.7 for those 65-69 years of age and 16.4 for those 80 years and older.
Other common cancers occurring in the breast cancer survivor population were lung and colon cancers, investigator Kerri Clough-Gorr, D.Sc., reported at the annual meeting of the International Society of Geriatric Oncology. Hematologic malignancies, melanoma, and urinary and digestive tumors were also observed.
"Relative breast cancer survival rates are quite high in the United States, at over 89% at 5 years [after a diagnosis]," said Dr. Clough-Gorr of Boston University and the Institute of Social and Preventative Medicine at the University of Bern (Switzerland).
"Importantly, the vast majority of women with breast cancer become long-term survivors, and they are at risk for developing subsequent malignancies," she added.
It is estimated that there are 2.4 million women in the United States with a history of breast cancer, and the current study aimed to look at survivors’ risk of developing multiple primary cancers over a 20-year follow-up period.
The study analyzed data from 12 SEER (Surveillance, Epidemiology, and End Results) program registry sites on 110,440 women diagnosed with a first primary breast cancer between 1986 and 1994. The women were evaluated for the development of other primary cancers or death up until 2006.
In addition to being more likely to develop another primary cancer, older women were more likely to develop it more quickly. The mean time to develop any MPM was 50 months for women 80-plus years compared with 100 months in those under 65 years. Values for women aged 65-69 and 70-79 were 85 and 72 months.
The stage of the first primary breast cancer at diagnosis did not affect the risk of subsequent MPM, nor were any sociodemographic factors or the year of diagnosis found to be of influence.
"Age was the strongest, significant predictor of multiple primary malignancy risk in this population," Dr. Clough-Gorr noted, adding that the risk was highest in women 70-79 years, with a hazard ratio of 1.48. Hazard ratios for ages 65-69 and 80-plus years were 1.41 and 1.32.
"These findings suggest there are age-related differences in [the] risk of developing an MPM after a primary breast cancer diagnosis," Ms. Clough-Gorr concluded. "In this population, there were no other MPM risk factors that were identified."
The study was supported by the National Cancer Institute. Dr. Clough-Gorr said she had no relevant financial disclosures.
MANCHESTER, ENGLAND – Older women who are breast cancer survivors have a greater risk of developing additional primary cancers in the long term than those under 65 years of age, according to an analysis of data on more than 100,000 survivors in the United States.
Women aged 70-79 years appear to have the highest risk of developing a multiple primary malignancy (MPM), with a crude 10-year incidence of 17.8/10,000 person-years. In comparisons, the rate of risk for survivors younger than 65 was 11.7, increasing to 16.7 for those 65-69 years of age and 16.4 for those 80 years and older.
Other common cancers occurring in the breast cancer survivor population were lung and colon cancers, investigator Kerri Clough-Gorr, D.Sc., reported at the annual meeting of the International Society of Geriatric Oncology. Hematologic malignancies, melanoma, and urinary and digestive tumors were also observed.
"Relative breast cancer survival rates are quite high in the United States, at over 89% at 5 years [after a diagnosis]," said Dr. Clough-Gorr of Boston University and the Institute of Social and Preventative Medicine at the University of Bern (Switzerland).
"Importantly, the vast majority of women with breast cancer become long-term survivors, and they are at risk for developing subsequent malignancies," she added.
It is estimated that there are 2.4 million women in the United States with a history of breast cancer, and the current study aimed to look at survivors’ risk of developing multiple primary cancers over a 20-year follow-up period.
The study analyzed data from 12 SEER (Surveillance, Epidemiology, and End Results) program registry sites on 110,440 women diagnosed with a first primary breast cancer between 1986 and 1994. The women were evaluated for the development of other primary cancers or death up until 2006.
In addition to being more likely to develop another primary cancer, older women were more likely to develop it more quickly. The mean time to develop any MPM was 50 months for women 80-plus years compared with 100 months in those under 65 years. Values for women aged 65-69 and 70-79 were 85 and 72 months.
The stage of the first primary breast cancer at diagnosis did not affect the risk of subsequent MPM, nor were any sociodemographic factors or the year of diagnosis found to be of influence.
"Age was the strongest, significant predictor of multiple primary malignancy risk in this population," Dr. Clough-Gorr noted, adding that the risk was highest in women 70-79 years, with a hazard ratio of 1.48. Hazard ratios for ages 65-69 and 80-plus years were 1.41 and 1.32.
"These findings suggest there are age-related differences in [the] risk of developing an MPM after a primary breast cancer diagnosis," Ms. Clough-Gorr concluded. "In this population, there were no other MPM risk factors that were identified."
The study was supported by the National Cancer Institute. Dr. Clough-Gorr said she had no relevant financial disclosures.
MANCHESTER, ENGLAND – Older women who are breast cancer survivors have a greater risk of developing additional primary cancers in the long term than those under 65 years of age, according to an analysis of data on more than 100,000 survivors in the United States.
Women aged 70-79 years appear to have the highest risk of developing a multiple primary malignancy (MPM), with a crude 10-year incidence of 17.8/10,000 person-years. In comparisons, the rate of risk for survivors younger than 65 was 11.7, increasing to 16.7 for those 65-69 years of age and 16.4 for those 80 years and older.
Other common cancers occurring in the breast cancer survivor population were lung and colon cancers, investigator Kerri Clough-Gorr, D.Sc., reported at the annual meeting of the International Society of Geriatric Oncology. Hematologic malignancies, melanoma, and urinary and digestive tumors were also observed.
"Relative breast cancer survival rates are quite high in the United States, at over 89% at 5 years [after a diagnosis]," said Dr. Clough-Gorr of Boston University and the Institute of Social and Preventative Medicine at the University of Bern (Switzerland).
"Importantly, the vast majority of women with breast cancer become long-term survivors, and they are at risk for developing subsequent malignancies," she added.
It is estimated that there are 2.4 million women in the United States with a history of breast cancer, and the current study aimed to look at survivors’ risk of developing multiple primary cancers over a 20-year follow-up period.
The study analyzed data from 12 SEER (Surveillance, Epidemiology, and End Results) program registry sites on 110,440 women diagnosed with a first primary breast cancer between 1986 and 1994. The women were evaluated for the development of other primary cancers or death up until 2006.
In addition to being more likely to develop another primary cancer, older women were more likely to develop it more quickly. The mean time to develop any MPM was 50 months for women 80-plus years compared with 100 months in those under 65 years. Values for women aged 65-69 and 70-79 were 85 and 72 months.
The stage of the first primary breast cancer at diagnosis did not affect the risk of subsequent MPM, nor were any sociodemographic factors or the year of diagnosis found to be of influence.
"Age was the strongest, significant predictor of multiple primary malignancy risk in this population," Dr. Clough-Gorr noted, adding that the risk was highest in women 70-79 years, with a hazard ratio of 1.48. Hazard ratios for ages 65-69 and 80-plus years were 1.41 and 1.32.
"These findings suggest there are age-related differences in [the] risk of developing an MPM after a primary breast cancer diagnosis," Ms. Clough-Gorr concluded. "In this population, there were no other MPM risk factors that were identified."
The study was supported by the National Cancer Institute. Dr. Clough-Gorr said she had no relevant financial disclosures.
AT THE ANNUAL MEETING OF THE INTERNATIONAL SOCIETY OF GERIATRIC ONCOLOGY
Major Finding: Crude 10-year incidences of multiple primary malignancy were 11.7, 16.7, 17.8, and 16.4/10,000 person-years for women younger than 65, 65-69, 70-79, and 80 years and older, respectively.
Data Source: Investigators analyzed SEER data on 110,440 female breast cancer survivors followed for more than 20 years.
Disclosures: The study was supported by the National Cancer Institute. Dr. Clough-Gorr said she had no relevant financial disclosures.
Rivaroxaban Now Approved for DVT, PE Treatment
The oral anticoagulant rivaroxaban has been approved for the treatment of deep vein thrombosis or pulmonary embolism and for reducing the recurrence of DVT and PE after initial treatment, the Food and Drug Administration announced Nov. 5.
The expanded approval was based on the results of three studies of almost 9,500 patients with a DVT or PE which found that treatment with rivaroxaban was as effective as the combination of the low molecular weight heparin enoxaparin and a vitamin K antagonist in treating DVT and PE. In one of the studies, continued treatment with rivaroxaban reduced the risk of recurrent DVT and PE, according to an FDA statement.
Rivaroxaban, a factor Xa inhibitor, was initially approved in July 2011 for prophylaxis of DVT or PE in patients undergoing hip replacement or knee-replacement surgery, at a dose of 10 mg orally once a day. Marketed as Xarelto by Janssen Pharmaceuticals, it received in November 2011 a second indication for reducing the risk of stroke in patients with nonvalvular atrial fibrillation.
The FDA is currently reviewing the company’s applications to approve rivaroxaban for reducing the risk of stent thrombosis in patients with acute coronary syndrome and for reducing the risk of secondary cardiovascular events in patients with ACS, according to Janssen.
The oral anticoagulant rivaroxaban has been approved for the treatment of deep vein thrombosis or pulmonary embolism and for reducing the recurrence of DVT and PE after initial treatment, the Food and Drug Administration announced Nov. 5.
The expanded approval was based on the results of three studies of almost 9,500 patients with a DVT or PE which found that treatment with rivaroxaban was as effective as the combination of the low molecular weight heparin enoxaparin and a vitamin K antagonist in treating DVT and PE. In one of the studies, continued treatment with rivaroxaban reduced the risk of recurrent DVT and PE, according to an FDA statement.
Rivaroxaban, a factor Xa inhibitor, was initially approved in July 2011 for prophylaxis of DVT or PE in patients undergoing hip replacement or knee-replacement surgery, at a dose of 10 mg orally once a day. Marketed as Xarelto by Janssen Pharmaceuticals, it received in November 2011 a second indication for reducing the risk of stroke in patients with nonvalvular atrial fibrillation.
The FDA is currently reviewing the company’s applications to approve rivaroxaban for reducing the risk of stent thrombosis in patients with acute coronary syndrome and for reducing the risk of secondary cardiovascular events in patients with ACS, according to Janssen.
The oral anticoagulant rivaroxaban has been approved for the treatment of deep vein thrombosis or pulmonary embolism and for reducing the recurrence of DVT and PE after initial treatment, the Food and Drug Administration announced Nov. 5.
The expanded approval was based on the results of three studies of almost 9,500 patients with a DVT or PE which found that treatment with rivaroxaban was as effective as the combination of the low molecular weight heparin enoxaparin and a vitamin K antagonist in treating DVT and PE. In one of the studies, continued treatment with rivaroxaban reduced the risk of recurrent DVT and PE, according to an FDA statement.
Rivaroxaban, a factor Xa inhibitor, was initially approved in July 2011 for prophylaxis of DVT or PE in patients undergoing hip replacement or knee-replacement surgery, at a dose of 10 mg orally once a day. Marketed as Xarelto by Janssen Pharmaceuticals, it received in November 2011 a second indication for reducing the risk of stroke in patients with nonvalvular atrial fibrillation.
The FDA is currently reviewing the company’s applications to approve rivaroxaban for reducing the risk of stent thrombosis in patients with acute coronary syndrome and for reducing the risk of secondary cardiovascular events in patients with ACS, according to Janssen.
Memantine Protects Cognitive Function After Whole Brain Irradiation
BOSTON – Memantine, a drug normally prescribed for slowing cognitive decline in Alzheimer’s disease, can help to preserve cognitive function in cancer patients who have undergone whole brain irradiation, a study showed.
In a phase III trial, patients with brain metastases were randomly assigned to take 20 mg memantine (Namenda) or placebo daily for 24 weeks after whole brain radiation therapy (WBRT). The memantine cohort had a 17% relative reduction in cognitive decline compared with patients who got a placebo, Dr. Nadia N. Laack reported at the annual meeting of the American Society for Radiation Oncology.
The finding teetered on the edge of statistical significance (P = .059), however, because only one-third of patients (32%) completed the 24 weeks of drug therapy, due to death (survival was poorer than expected), disease progression, or noncompliance, said Dr. Laack. a radiation oncologist at the Mayo Clinic in Rochester, Minn.
"Overall, we feel that the weight of evidence supports our conclusion that memantine helps to preserve cognitive function after whole brain radiotherapy in patients with brain metastases," Dr. Laack said at a briefing prior to presenting the data at a plenary session.
WBRT is associated with cognitive impairment in a majority of patients who receive it, Dr. Laack said, noting that at 4 months post radiation, 60% of patients will have declines in one or more cognitive domains.
Because the mechanism of decline is similar to that seen with Alzheimer\'s and vascular dementias, and because memantine has been shown to modestly improve mild to moderate cognition in both dementia types, Dr. Laack and his colleagues hypothesized that it might protect brains exposed to therapeutic doses of radiation.
A total of 508 patients were tested at baseline and at 8, 16, 24, and 52 weeks after radiation with 37.5 Gy in 15 fractions. They were evaluated with MRI and cognitive assessment; domains of memory, processing speed, executive function, global function, self-reported cognitive function, and quality of life were evaluated. Median overall follow-up was 12.4 months.
There were no differences between the treatment groups in overall survival at a median of 6 months or in progression-free survival at 5 months.
Among 149 patients available for analysis at 24 weeks, patients who took memantine had a significantly longer time to memory decline than did those on placebo (P = .02), and had a trend toward less decline in the primary end point, the Hopkins Verbal Learning Test–Revised delayed recall instrument (median decline of 0 standard deviation, vs. –2 standard deviations for patients on placebo).
For the secondary objective of cognitive function decline/failure, defined as a change greater than reversible cognitive impairment or 2 standard deviations decline from baseline on any domain of brain function, the hazard ratio for memantine at 24 weeks was 0.784 (P = .01), indicating a significant reduction in the incidence of cognitive dysfunction.
"Although memantine was discontinued at 6 months, the effect on cognitive function was maintained for the duration of the trial, suggesting that memantine may be preventing radiation injury rather than simply treating cognitive dysfunction," Dr. Laack said.
The trial was sponsored by grants from the National Cancer Institute and Forest Pharmaceuticals. Dr. Laack reported no relevant financial disclosures.
BOSTON – Memantine, a drug normally prescribed for slowing cognitive decline in Alzheimer’s disease, can help to preserve cognitive function in cancer patients who have undergone whole brain irradiation, a study showed.
In a phase III trial, patients with brain metastases were randomly assigned to take 20 mg memantine (Namenda) or placebo daily for 24 weeks after whole brain radiation therapy (WBRT). The memantine cohort had a 17% relative reduction in cognitive decline compared with patients who got a placebo, Dr. Nadia N. Laack reported at the annual meeting of the American Society for Radiation Oncology.
The finding teetered on the edge of statistical significance (P = .059), however, because only one-third of patients (32%) completed the 24 weeks of drug therapy, due to death (survival was poorer than expected), disease progression, or noncompliance, said Dr. Laack. a radiation oncologist at the Mayo Clinic in Rochester, Minn.
"Overall, we feel that the weight of evidence supports our conclusion that memantine helps to preserve cognitive function after whole brain radiotherapy in patients with brain metastases," Dr. Laack said at a briefing prior to presenting the data at a plenary session.
WBRT is associated with cognitive impairment in a majority of patients who receive it, Dr. Laack said, noting that at 4 months post radiation, 60% of patients will have declines in one or more cognitive domains.
Because the mechanism of decline is similar to that seen with Alzheimer\'s and vascular dementias, and because memantine has been shown to modestly improve mild to moderate cognition in both dementia types, Dr. Laack and his colleagues hypothesized that it might protect brains exposed to therapeutic doses of radiation.
A total of 508 patients were tested at baseline and at 8, 16, 24, and 52 weeks after radiation with 37.5 Gy in 15 fractions. They were evaluated with MRI and cognitive assessment; domains of memory, processing speed, executive function, global function, self-reported cognitive function, and quality of life were evaluated. Median overall follow-up was 12.4 months.
There were no differences between the treatment groups in overall survival at a median of 6 months or in progression-free survival at 5 months.
Among 149 patients available for analysis at 24 weeks, patients who took memantine had a significantly longer time to memory decline than did those on placebo (P = .02), and had a trend toward less decline in the primary end point, the Hopkins Verbal Learning Test–Revised delayed recall instrument (median decline of 0 standard deviation, vs. –2 standard deviations for patients on placebo).
For the secondary objective of cognitive function decline/failure, defined as a change greater than reversible cognitive impairment or 2 standard deviations decline from baseline on any domain of brain function, the hazard ratio for memantine at 24 weeks was 0.784 (P = .01), indicating a significant reduction in the incidence of cognitive dysfunction.
"Although memantine was discontinued at 6 months, the effect on cognitive function was maintained for the duration of the trial, suggesting that memantine may be preventing radiation injury rather than simply treating cognitive dysfunction," Dr. Laack said.
The trial was sponsored by grants from the National Cancer Institute and Forest Pharmaceuticals. Dr. Laack reported no relevant financial disclosures.
BOSTON – Memantine, a drug normally prescribed for slowing cognitive decline in Alzheimer’s disease, can help to preserve cognitive function in cancer patients who have undergone whole brain irradiation, a study showed.
In a phase III trial, patients with brain metastases were randomly assigned to take 20 mg memantine (Namenda) or placebo daily for 24 weeks after whole brain radiation therapy (WBRT). The memantine cohort had a 17% relative reduction in cognitive decline compared with patients who got a placebo, Dr. Nadia N. Laack reported at the annual meeting of the American Society for Radiation Oncology.
The finding teetered on the edge of statistical significance (P = .059), however, because only one-third of patients (32%) completed the 24 weeks of drug therapy, due to death (survival was poorer than expected), disease progression, or noncompliance, said Dr. Laack. a radiation oncologist at the Mayo Clinic in Rochester, Minn.
"Overall, we feel that the weight of evidence supports our conclusion that memantine helps to preserve cognitive function after whole brain radiotherapy in patients with brain metastases," Dr. Laack said at a briefing prior to presenting the data at a plenary session.
WBRT is associated with cognitive impairment in a majority of patients who receive it, Dr. Laack said, noting that at 4 months post radiation, 60% of patients will have declines in one or more cognitive domains.
Because the mechanism of decline is similar to that seen with Alzheimer\'s and vascular dementias, and because memantine has been shown to modestly improve mild to moderate cognition in both dementia types, Dr. Laack and his colleagues hypothesized that it might protect brains exposed to therapeutic doses of radiation.
A total of 508 patients were tested at baseline and at 8, 16, 24, and 52 weeks after radiation with 37.5 Gy in 15 fractions. They were evaluated with MRI and cognitive assessment; domains of memory, processing speed, executive function, global function, self-reported cognitive function, and quality of life were evaluated. Median overall follow-up was 12.4 months.
There were no differences between the treatment groups in overall survival at a median of 6 months or in progression-free survival at 5 months.
Among 149 patients available for analysis at 24 weeks, patients who took memantine had a significantly longer time to memory decline than did those on placebo (P = .02), and had a trend toward less decline in the primary end point, the Hopkins Verbal Learning Test–Revised delayed recall instrument (median decline of 0 standard deviation, vs. –2 standard deviations for patients on placebo).
For the secondary objective of cognitive function decline/failure, defined as a change greater than reversible cognitive impairment or 2 standard deviations decline from baseline on any domain of brain function, the hazard ratio for memantine at 24 weeks was 0.784 (P = .01), indicating a significant reduction in the incidence of cognitive dysfunction.
"Although memantine was discontinued at 6 months, the effect on cognitive function was maintained for the duration of the trial, suggesting that memantine may be preventing radiation injury rather than simply treating cognitive dysfunction," Dr. Laack said.
The trial was sponsored by grants from the National Cancer Institute and Forest Pharmaceuticals. Dr. Laack reported no relevant financial disclosures.
AT THE ANNUAL MEETING OF THE AMERICAN SOCIETY FOR RADIATION ONCOLOGY
Major Finding: Cancer patients with brain metastases had a 17% relative reduction in cognitive decline after whole brain radiation if they took memantine vs. placebo for 24 weeks.
Data Source: Investigators randomized 508 patients in a placebo-controlled clinical trial.
Disclosures: The trial was sponsored by grants from the National Cancer Institute and Forest Pharmaceuticals. Dr. Laack reported no relevant financial disclosures.
50 Practical Medication Tips at End of Life
Patients with a life-limiting illness frequently experience pain and other symptoms. It is important to pay close attention when medication therapy is used to manage these symptoms. Occasionally, practitioners need to be creative in selecting, dosing, administering, and discontinuing medications at the end of life because of the patient’s changing health care needs.
In the video below, Dr. Kathryn Walker and Dr. Lynn McPherson of the University of Maryland discuss the role of the pharmacist in the hospital and hospice settings, as well as a few of their favorite medication tips and tricks in end-of-life care.
This article offers practical end-of-life medication tips including, but not limited to, medication administration; guidance on how to increase and decrease doses; medication selection for difficult to-treat patients; alternative dosage formulations; routes of medication administration; debridement medication regimens; and appropriate drug therapy selection. Dr. McPherson and Dr. Walker discuss how to deal with changing the goals of care for your dying patients and their families. They offer suggestions on how to integrate some helpful end-of-life medication tips into your practice.
*For a PDF of the full article, click on the link to the left of this introduction.
Patients with a life-limiting illness frequently experience pain and other symptoms. It is important to pay close attention when medication therapy is used to manage these symptoms. Occasionally, practitioners need to be creative in selecting, dosing, administering, and discontinuing medications at the end of life because of the patient’s changing health care needs.
In the video below, Dr. Kathryn Walker and Dr. Lynn McPherson of the University of Maryland discuss the role of the pharmacist in the hospital and hospice settings, as well as a few of their favorite medication tips and tricks in end-of-life care.
This article offers practical end-of-life medication tips including, but not limited to, medication administration; guidance on how to increase and decrease doses; medication selection for difficult to-treat patients; alternative dosage formulations; routes of medication administration; debridement medication regimens; and appropriate drug therapy selection. Dr. McPherson and Dr. Walker discuss how to deal with changing the goals of care for your dying patients and their families. They offer suggestions on how to integrate some helpful end-of-life medication tips into your practice.
*For a PDF of the full article, click on the link to the left of this introduction.
Patients with a life-limiting illness frequently experience pain and other symptoms. It is important to pay close attention when medication therapy is used to manage these symptoms. Occasionally, practitioners need to be creative in selecting, dosing, administering, and discontinuing medications at the end of life because of the patient’s changing health care needs.
In the video below, Dr. Kathryn Walker and Dr. Lynn McPherson of the University of Maryland discuss the role of the pharmacist in the hospital and hospice settings, as well as a few of their favorite medication tips and tricks in end-of-life care.
This article offers practical end-of-life medication tips including, but not limited to, medication administration; guidance on how to increase and decrease doses; medication selection for difficult to-treat patients; alternative dosage formulations; routes of medication administration; debridement medication regimens; and appropriate drug therapy selection. Dr. McPherson and Dr. Walker discuss how to deal with changing the goals of care for your dying patients and their families. They offer suggestions on how to integrate some helpful end-of-life medication tips into your practice.
*For a PDF of the full article, click on the link to the left of this introduction.
ASRM: Egg Freezing No Longer 'Experimental'
Oocyte cryopreservation is now an officially sanctioned option for young women whose medical treatments may endanger their fertility.
A report by the American Society for Reproductive Medicine found that advances in egg-freezing techniques now produce rates of pregnancy and healthy babies comparable to those seen with vitro fertilization (IVF) using fresh eggs.
The society went so far as to remove the word "experimental" from the paper, in the hopes that insurance may begin to pay for egg preservation for young women who face gonadotoxic treatments, such as chemotherapy for cancer.
"We are still in the early phases of figuring out the best candidate and the best time of life to elect doing this."
"Egg freezing can be used for patients with medical indications for losing their fertility, such as cancer, impending ovarian failure, or even genetic conditions like Turner syndrome," Dr. Samantha Pfeifer, the paper’s lead author, said during a press briefing. Other indications include a failure to retrieve sufficient sperm on the day of IVF, or the cryopreservation of eggs for couples who can’t, or don’t want to, freeze embryos.
What the paper doesn’t support, however, is using oocyte cryopreservation to delay childbearing, or as any kind of an "insurance policy" for younger women against what might happen to their fertility some time in the future.
"We are aware that this has been marketed vigorously to ensure against future infertility," said Dr. Pfeifer, chair of the ASRM Practice Committee. "Conceptually this seems like a good idea, but there are no data to say that it would help many women. Only 15% of couples will ever seek treatment for infertility, and only a subset of those will attempt IVF, and only a subset of those would need to consider cryopreservation. Only women who were lucky enough to freeze eggs [during their youth], and then become infertile, would be helped by this."
The report examined data from 112 papers on oocyte cryopreservation safety and efficacy. "The largest and most compelling randomized controlled trial compared the use of fresh versus vitrified donor oocytes in 600 recipients," the report noted. "The investigators found that 92.5% of vitrified oocytes survived warming, and that there were no significant differences in fertilization rates (74% vitrified vs. 73% fresh), implantation rates (40% vs. 41%), and pregnancy rates per transfer (55.4% vs. 55.6%) between groups."
The studies’ findings also eased concerns that freezing might compromise egg quality by damaging the meiotic spindle, Dr. Pfeifer said. Advances in the technology of freezing have largely ameliorated that fear.
"Despite concerns regarding spindle abnormalities in cryopreserved oocytes, the incidence of chromosomal abnormalities in human embryos obtained from cryopreserved oocytes is no different from that of control embryos," according to the report. A recent review of more than 900 babies born from frozen eggs found no increased risk of congenital abnormalities, compared with the background population.
However, the paper noted, there are not yet any long-term developmental data on these children.
IVF with frozen oocytes is most successful with women in their 20s and early 30s – as in any other assisted reproduction technique, said coauthor Dr. Eric Widra. This truth touches directly on the issue of elective egg freezing.
"There’s an inherent conflict between the desire to freeze eggs and the need to do it," he said during the briefing. "Young women in their 20s are unlikely to have infertility, and if they do, it’s unlikely to be due to trouble with their eggs, so freezing is an insurance policy many will never need. For the older patient, freezing provides a false sense of security; technically it would be possible, but it may not give them a good chance of a live birth.
"We are still in the early phases of figuring out the best candidate and the best time of life to elect doing this," he said.
Dr. Pfeifer agreed. "We think this application should be used with caution and not be offered indiscriminately to everyone, without counseling about the options. A lot of the women interested in this are in their late 30s and early 40s, and their chance of having a live birth is not as good as younger women. These older patients must be counseled on this. This is not a technology that says, ‘Freeze your eggs so you will have more options down the road.’ The best way to conceive is with your own eggs, through natural intercourse. There are no data that support this as a social mechanism to delay childbearing."
Dr. Pfeifer and Dr. Widra said they had no relevant financial disclosures.
Oocyte cryopreservation is now an officially sanctioned option for young women whose medical treatments may endanger their fertility.
A report by the American Society for Reproductive Medicine found that advances in egg-freezing techniques now produce rates of pregnancy and healthy babies comparable to those seen with vitro fertilization (IVF) using fresh eggs.
The society went so far as to remove the word "experimental" from the paper, in the hopes that insurance may begin to pay for egg preservation for young women who face gonadotoxic treatments, such as chemotherapy for cancer.
"We are still in the early phases of figuring out the best candidate and the best time of life to elect doing this."
"Egg freezing can be used for patients with medical indications for losing their fertility, such as cancer, impending ovarian failure, or even genetic conditions like Turner syndrome," Dr. Samantha Pfeifer, the paper’s lead author, said during a press briefing. Other indications include a failure to retrieve sufficient sperm on the day of IVF, or the cryopreservation of eggs for couples who can’t, or don’t want to, freeze embryos.
What the paper doesn’t support, however, is using oocyte cryopreservation to delay childbearing, or as any kind of an "insurance policy" for younger women against what might happen to their fertility some time in the future.
"We are aware that this has been marketed vigorously to ensure against future infertility," said Dr. Pfeifer, chair of the ASRM Practice Committee. "Conceptually this seems like a good idea, but there are no data to say that it would help many women. Only 15% of couples will ever seek treatment for infertility, and only a subset of those will attempt IVF, and only a subset of those would need to consider cryopreservation. Only women who were lucky enough to freeze eggs [during their youth], and then become infertile, would be helped by this."
The report examined data from 112 papers on oocyte cryopreservation safety and efficacy. "The largest and most compelling randomized controlled trial compared the use of fresh versus vitrified donor oocytes in 600 recipients," the report noted. "The investigators found that 92.5% of vitrified oocytes survived warming, and that there were no significant differences in fertilization rates (74% vitrified vs. 73% fresh), implantation rates (40% vs. 41%), and pregnancy rates per transfer (55.4% vs. 55.6%) between groups."
The studies’ findings also eased concerns that freezing might compromise egg quality by damaging the meiotic spindle, Dr. Pfeifer said. Advances in the technology of freezing have largely ameliorated that fear.
"Despite concerns regarding spindle abnormalities in cryopreserved oocytes, the incidence of chromosomal abnormalities in human embryos obtained from cryopreserved oocytes is no different from that of control embryos," according to the report. A recent review of more than 900 babies born from frozen eggs found no increased risk of congenital abnormalities, compared with the background population.
However, the paper noted, there are not yet any long-term developmental data on these children.
IVF with frozen oocytes is most successful with women in their 20s and early 30s – as in any other assisted reproduction technique, said coauthor Dr. Eric Widra. This truth touches directly on the issue of elective egg freezing.
"There’s an inherent conflict between the desire to freeze eggs and the need to do it," he said during the briefing. "Young women in their 20s are unlikely to have infertility, and if they do, it’s unlikely to be due to trouble with their eggs, so freezing is an insurance policy many will never need. For the older patient, freezing provides a false sense of security; technically it would be possible, but it may not give them a good chance of a live birth.
"We are still in the early phases of figuring out the best candidate and the best time of life to elect doing this," he said.
Dr. Pfeifer agreed. "We think this application should be used with caution and not be offered indiscriminately to everyone, without counseling about the options. A lot of the women interested in this are in their late 30s and early 40s, and their chance of having a live birth is not as good as younger women. These older patients must be counseled on this. This is not a technology that says, ‘Freeze your eggs so you will have more options down the road.’ The best way to conceive is with your own eggs, through natural intercourse. There are no data that support this as a social mechanism to delay childbearing."
Dr. Pfeifer and Dr. Widra said they had no relevant financial disclosures.
Oocyte cryopreservation is now an officially sanctioned option for young women whose medical treatments may endanger their fertility.
A report by the American Society for Reproductive Medicine found that advances in egg-freezing techniques now produce rates of pregnancy and healthy babies comparable to those seen with vitro fertilization (IVF) using fresh eggs.
The society went so far as to remove the word "experimental" from the paper, in the hopes that insurance may begin to pay for egg preservation for young women who face gonadotoxic treatments, such as chemotherapy for cancer.
"We are still in the early phases of figuring out the best candidate and the best time of life to elect doing this."
"Egg freezing can be used for patients with medical indications for losing their fertility, such as cancer, impending ovarian failure, or even genetic conditions like Turner syndrome," Dr. Samantha Pfeifer, the paper’s lead author, said during a press briefing. Other indications include a failure to retrieve sufficient sperm on the day of IVF, or the cryopreservation of eggs for couples who can’t, or don’t want to, freeze embryos.
What the paper doesn’t support, however, is using oocyte cryopreservation to delay childbearing, or as any kind of an "insurance policy" for younger women against what might happen to their fertility some time in the future.
"We are aware that this has been marketed vigorously to ensure against future infertility," said Dr. Pfeifer, chair of the ASRM Practice Committee. "Conceptually this seems like a good idea, but there are no data to say that it would help many women. Only 15% of couples will ever seek treatment for infertility, and only a subset of those will attempt IVF, and only a subset of those would need to consider cryopreservation. Only women who were lucky enough to freeze eggs [during their youth], and then become infertile, would be helped by this."
The report examined data from 112 papers on oocyte cryopreservation safety and efficacy. "The largest and most compelling randomized controlled trial compared the use of fresh versus vitrified donor oocytes in 600 recipients," the report noted. "The investigators found that 92.5% of vitrified oocytes survived warming, and that there were no significant differences in fertilization rates (74% vitrified vs. 73% fresh), implantation rates (40% vs. 41%), and pregnancy rates per transfer (55.4% vs. 55.6%) between groups."
The studies’ findings also eased concerns that freezing might compromise egg quality by damaging the meiotic spindle, Dr. Pfeifer said. Advances in the technology of freezing have largely ameliorated that fear.
"Despite concerns regarding spindle abnormalities in cryopreserved oocytes, the incidence of chromosomal abnormalities in human embryos obtained from cryopreserved oocytes is no different from that of control embryos," according to the report. A recent review of more than 900 babies born from frozen eggs found no increased risk of congenital abnormalities, compared with the background population.
However, the paper noted, there are not yet any long-term developmental data on these children.
IVF with frozen oocytes is most successful with women in their 20s and early 30s – as in any other assisted reproduction technique, said coauthor Dr. Eric Widra. This truth touches directly on the issue of elective egg freezing.
"There’s an inherent conflict between the desire to freeze eggs and the need to do it," he said during the briefing. "Young women in their 20s are unlikely to have infertility, and if they do, it’s unlikely to be due to trouble with their eggs, so freezing is an insurance policy many will never need. For the older patient, freezing provides a false sense of security; technically it would be possible, but it may not give them a good chance of a live birth.
"We are still in the early phases of figuring out the best candidate and the best time of life to elect doing this," he said.
Dr. Pfeifer agreed. "We think this application should be used with caution and not be offered indiscriminately to everyone, without counseling about the options. A lot of the women interested in this are in their late 30s and early 40s, and their chance of having a live birth is not as good as younger women. These older patients must be counseled on this. This is not a technology that says, ‘Freeze your eggs so you will have more options down the road.’ The best way to conceive is with your own eggs, through natural intercourse. There are no data that support this as a social mechanism to delay childbearing."
Dr. Pfeifer and Dr. Widra said they had no relevant financial disclosures.
Calcium Gluconate and Magnesium Sulfate in Preventing Neurotoxicity in Patients With Colon Cancer or Rectal Cancer Receiving Oxaliplatin-Based Combination Chemotherapy
Objectives: This placebo-controlled, randomized, phase III trial is comparing two different infusion schedules for administering calcium gluconate and magnesium sulfate with FOLFOX chemotherapy to determine which is more effective in reducing neurotoxicity in patients receiving the oxaliplatin-based regimen for colon cancer or rectal cancer.
Key entry or exclusion criteria: Patient must have undergone curative resection and is considered to have stage II or III disease or completely resected stage IV disease with no evidence of residual tumor.
Locations: 396 sites .
Goal: 354 patients.
Study sponsor: North Central Cancer Treatment Group in collaboration with the National Cancer Institute.
Link for more information: clinicaltrials.gov/ct2/show/NCT01099449
NIH clinical trials identifier: NCT01099449
Objectives: This placebo-controlled, randomized, phase III trial is comparing two different infusion schedules for administering calcium gluconate and magnesium sulfate with FOLFOX chemotherapy to determine which is more effective in reducing neurotoxicity in patients receiving the oxaliplatin-based regimen for colon cancer or rectal cancer.
Key entry or exclusion criteria: Patient must have undergone curative resection and is considered to have stage II or III disease or completely resected stage IV disease with no evidence of residual tumor.
Locations: 396 sites .
Goal: 354 patients.
Study sponsor: North Central Cancer Treatment Group in collaboration with the National Cancer Institute.
Link for more information: clinicaltrials.gov/ct2/show/NCT01099449
NIH clinical trials identifier: NCT01099449
Objectives: This placebo-controlled, randomized, phase III trial is comparing two different infusion schedules for administering calcium gluconate and magnesium sulfate with FOLFOX chemotherapy to determine which is more effective in reducing neurotoxicity in patients receiving the oxaliplatin-based regimen for colon cancer or rectal cancer.
Key entry or exclusion criteria: Patient must have undergone curative resection and is considered to have stage II or III disease or completely resected stage IV disease with no evidence of residual tumor.
Locations: 396 sites .
Goal: 354 patients.
Study sponsor: North Central Cancer Treatment Group in collaboration with the National Cancer Institute.
Link for more information: clinicaltrials.gov/ct2/show/NCT01099449
NIH clinical trials identifier: NCT01099449
Management of dermatological toxicities in patients receiving EGFR inhibitors
Patients receiving treatment with epidermal growth factor receptor inhibitors often experience dermatological toxicities. The majority of patients develop skin rash, and may also experience adverse nail and periungual alterations. EGFR inhibitors have become part of the standard of care for several solid tumors, including metastatic colorectal cancer, cancers of the head and neck, and non small-cell lung cancer, thus adequate management of these side effects is necessary to ensure patient compliance to therapy, as well as to maximize patient comfort and quality of life. This review presents a protocol our center optimized to successfully manage cetuximab-associated acneiform rash and nail toxicities.
Click on the PDF icon at the top of this introduction to read the full article.
Patients receiving treatment with epidermal growth factor receptor inhibitors often experience dermatological toxicities. The majority of patients develop skin rash, and may also experience adverse nail and periungual alterations. EGFR inhibitors have become part of the standard of care for several solid tumors, including metastatic colorectal cancer, cancers of the head and neck, and non small-cell lung cancer, thus adequate management of these side effects is necessary to ensure patient compliance to therapy, as well as to maximize patient comfort and quality of life. This review presents a protocol our center optimized to successfully manage cetuximab-associated acneiform rash and nail toxicities.
Click on the PDF icon at the top of this introduction to read the full article.
Patients receiving treatment with epidermal growth factor receptor inhibitors often experience dermatological toxicities. The majority of patients develop skin rash, and may also experience adverse nail and periungual alterations. EGFR inhibitors have become part of the standard of care for several solid tumors, including metastatic colorectal cancer, cancers of the head and neck, and non small-cell lung cancer, thus adequate management of these side effects is necessary to ensure patient compliance to therapy, as well as to maximize patient comfort and quality of life. This review presents a protocol our center optimized to successfully manage cetuximab-associated acneiform rash and nail toxicities.
Click on the PDF icon at the top of this introduction to read the full article.
Hypertension in cancer patients
Hypertension is the force of blood pushing against the walls of the arteries. It is measured as systolic pressure when the heart beats and pumps blood and as diastolic pressure in the arteries when the heart rests between beats. There are 4 stages in blood pressure classification—normal, prehypertension, stage 1, and stage 2. Hypertension affects approximately 50 million people in the United States and 1 billion people worldwide. People who are normotensive at age 55 years have a 90% chance of developing hypertension in their lifetime. Starting with a blood pressure of 115/75 mmHg, the risk of cardiovascular death doubles with each 20/10 mmHg increment...
*For PDFs of the full article and related Commentary, click on the links to the left of this introduction.
Hypertension is the force of blood pushing against the walls of the arteries. It is measured as systolic pressure when the heart beats and pumps blood and as diastolic pressure in the arteries when the heart rests between beats. There are 4 stages in blood pressure classification—normal, prehypertension, stage 1, and stage 2. Hypertension affects approximately 50 million people in the United States and 1 billion people worldwide. People who are normotensive at age 55 years have a 90% chance of developing hypertension in their lifetime. Starting with a blood pressure of 115/75 mmHg, the risk of cardiovascular death doubles with each 20/10 mmHg increment...
*For PDFs of the full article and related Commentary, click on the links to the left of this introduction.
Hypertension is the force of blood pushing against the walls of the arteries. It is measured as systolic pressure when the heart beats and pumps blood and as diastolic pressure in the arteries when the heart rests between beats. There are 4 stages in blood pressure classification—normal, prehypertension, stage 1, and stage 2. Hypertension affects approximately 50 million people in the United States and 1 billion people worldwide. People who are normotensive at age 55 years have a 90% chance of developing hypertension in their lifetime. Starting with a blood pressure of 115/75 mmHg, the risk of cardiovascular death doubles with each 20/10 mmHg increment...
*For PDFs of the full article and related Commentary, click on the links to the left of this introduction.
Avoiding Harmful Palliative Chemotherapy Treatment in the End of Life
Avoiding Harmful Palliative Chemotherapy Treatment in the End of Life: Development of a Brief Patient-Completed Questionnaire for Routine Assessment of Performance Status
Ulla Näppä, RN, MSc
Abstract
Background
Earlier studies have shown that up to 43% of patients with incurable cancer are treated with palliative chemotherapy in the last month of their lives. Although pretreatment blood tests are acceptable, the patient's general condition may not permit further palliative chemotherapy treatment (PCT). Presently, there is no patient self-assessment tool available to monitor performance status during PCT.
Objectives
To describe the development process of the Performance Status in Palliative Chemotherapy (PSPC) questionnaire, and the testing of its psychometric properties.
Methods
The questionnaire was developed by the authors based on the Eastern Cooperative Oncology Group Performance Status Rating (ECOG PSR) scale as well as their clinical experience with PCT. Adult patients who were diagnosed with epithelial cancers (n = 118) were enrolled to test the PSPC questionnaire for reliability, sensitivity for change, and validity.
Results
After stepwise modifications of the PSPC questionnaire, psychometric tests revealed acceptable values for reliability (via a test-retest method), sensitivity for change (via a comparison of patients with progressive disease over time), and validity (via a comparison of the PSPC vs the Edmonton Symptom Assessment System [ESAS]).
Limitations
At this stage of questionnaire development, we are unable to conclude whether the PSPC is superior to the conventional ECOG PSR in the evaluation of performance status and the prediction of chemotherapy response.
Conclusion
Psychometric tests suggest that the PSPC questionnaire may be a useful patient-completed tool in the late stages of cancer disease to routinely monitor performance status in palliative chemotherapy treatments so as to minimize the risk of inflicting more harm than good.
*For a PDF of the full article and accompanying commentary by Dr Jamie von Roenn, click on the links to the left of this introduction.
Avoiding Harmful Palliative Chemotherapy Treatment in the End of Life: Development of a Brief Patient-Completed Questionnaire for Routine Assessment of Performance Status
Ulla Näppä, RN, MSc
Abstract
Background
Earlier studies have shown that up to 43% of patients with incurable cancer are treated with palliative chemotherapy in the last month of their lives. Although pretreatment blood tests are acceptable, the patient's general condition may not permit further palliative chemotherapy treatment (PCT). Presently, there is no patient self-assessment tool available to monitor performance status during PCT.
Objectives
To describe the development process of the Performance Status in Palliative Chemotherapy (PSPC) questionnaire, and the testing of its psychometric properties.
Methods
The questionnaire was developed by the authors based on the Eastern Cooperative Oncology Group Performance Status Rating (ECOG PSR) scale as well as their clinical experience with PCT. Adult patients who were diagnosed with epithelial cancers (n = 118) were enrolled to test the PSPC questionnaire for reliability, sensitivity for change, and validity.
Results
After stepwise modifications of the PSPC questionnaire, psychometric tests revealed acceptable values for reliability (via a test-retest method), sensitivity for change (via a comparison of patients with progressive disease over time), and validity (via a comparison of the PSPC vs the Edmonton Symptom Assessment System [ESAS]).
Limitations
At this stage of questionnaire development, we are unable to conclude whether the PSPC is superior to the conventional ECOG PSR in the evaluation of performance status and the prediction of chemotherapy response.
Conclusion
Psychometric tests suggest that the PSPC questionnaire may be a useful patient-completed tool in the late stages of cancer disease to routinely monitor performance status in palliative chemotherapy treatments so as to minimize the risk of inflicting more harm than good.
*For a PDF of the full article and accompanying commentary by Dr Jamie von Roenn, click on the links to the left of this introduction.
Avoiding Harmful Palliative Chemotherapy Treatment in the End of Life: Development of a Brief Patient-Completed Questionnaire for Routine Assessment of Performance Status
Ulla Näppä, RN, MSc
Abstract
Background
Earlier studies have shown that up to 43% of patients with incurable cancer are treated with palliative chemotherapy in the last month of their lives. Although pretreatment blood tests are acceptable, the patient's general condition may not permit further palliative chemotherapy treatment (PCT). Presently, there is no patient self-assessment tool available to monitor performance status during PCT.
Objectives
To describe the development process of the Performance Status in Palliative Chemotherapy (PSPC) questionnaire, and the testing of its psychometric properties.
Methods
The questionnaire was developed by the authors based on the Eastern Cooperative Oncology Group Performance Status Rating (ECOG PSR) scale as well as their clinical experience with PCT. Adult patients who were diagnosed with epithelial cancers (n = 118) were enrolled to test the PSPC questionnaire for reliability, sensitivity for change, and validity.
Results
After stepwise modifications of the PSPC questionnaire, psychometric tests revealed acceptable values for reliability (via a test-retest method), sensitivity for change (via a comparison of patients with progressive disease over time), and validity (via a comparison of the PSPC vs the Edmonton Symptom Assessment System [ESAS]).
Limitations
At this stage of questionnaire development, we are unable to conclude whether the PSPC is superior to the conventional ECOG PSR in the evaluation of performance status and the prediction of chemotherapy response.
Conclusion
Psychometric tests suggest that the PSPC questionnaire may be a useful patient-completed tool in the late stages of cancer disease to routinely monitor performance status in palliative chemotherapy treatments so as to minimize the risk of inflicting more harm than good.
*For a PDF of the full article and accompanying commentary by Dr Jamie von Roenn, click on the links to the left of this introduction.