The Journal of Community and Supportive Oncology

Background Decision-making about palliative chemotherapy is complex because treatment goals include increased survival, symptom control, and functional improvement.

Objective To examine whether retrospective assessment by chemotherapy-experienced patients could inform decision-making support for future patients.

Methods 51 patients with thoracic or gastrointestinal malignancy, with no further systemic treatment options, completed the Functional Assessment of Chronic Illness Therapy–Treatment Satisfaction (FACIT-TS) survey and answered free-text questions about their past decisions about therapy.

Results FACIT-TS subscale of treatment effectiveness showed 36% of 49 eligible patients rating effectiveness as being worse than expected, 25% as expected, 37% better. 51% found side effects worse than expected, 19% as expected, and 28% better than expected. Textual analysis of survey responses indicated the majority of patients stood by their decision to take chemotherapy but wished they’d had more information about what to expect. Overall, 55% found chemotherapy to have been worthwhile, 37% not, 8% were undecided.

Limitations Accrual was slower than expected, in part because of a lack of awareness by patients that there were no further chemotherapy options available to them. Selection bias may have favored enrolment from teams open to soliciting patient feedback.

Conclusions Although the majority of patients stood by their decisions about palliative chemotherapy based on their understanding of the therapy at the time of making their decisions, there is a discrepancy between initial expectations about chemotherapy and retrospective assessment of chemotherapy effectiveness and side effects. The introduction of end-of-treatment feedback surveys as a routine quality assurance procedure should be considered.

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

Background Decision-making about palliative chemotherapy is complex because treatment goals include increased survival, symptom control, and functional improvement.

Objective To examine whether retrospective assessment by chemotherapy-experienced patients could inform decision-making support for future patients.

Methods 51 patients with thoracic or gastrointestinal malignancy, with no further systemic treatment options, completed the Functional Assessment of Chronic Illness Therapy–Treatment Satisfaction (FACIT-TS) survey and answered free-text questions about their past decisions about therapy.

Results FACIT-TS subscale of treatment effectiveness showed 36% of 49 eligible patients rating effectiveness as being worse than expected, 25% as expected, 37% better. 51% found side effects worse than expected, 19% as expected, and 28% better than expected. Textual analysis of survey responses indicated the majority of patients stood by their decision to take chemotherapy but wished they’d had more information about what to expect. Overall, 55% found chemotherapy to have been worthwhile, 37% not, 8% were undecided.

Limitations Accrual was slower than expected, in part because of a lack of awareness by patients that there were no further chemotherapy options available to them. Selection bias may have favored enrolment from teams open to soliciting patient feedback.

Conclusions Although the majority of patients stood by their decisions about palliative chemotherapy based on their understanding of the therapy at the time of making their decisions, there is a discrepancy between initial expectations about chemotherapy and retrospective assessment of chemotherapy effectiveness and side effects. The introduction of end-of-treatment feedback surveys as a routine quality assurance procedure should be considered.

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

Background Decision-making about palliative chemotherapy is complex because treatment goals include increased survival, symptom control, and functional improvement.

Objective To examine whether retrospective assessment by chemotherapy-experienced patients could inform decision-making support for future patients.

Methods 51 patients with thoracic or gastrointestinal malignancy, with no further systemic treatment options, completed the Functional Assessment of Chronic Illness Therapy–Treatment Satisfaction (FACIT-TS) survey and answered free-text questions about their past decisions about therapy.

Results FACIT-TS subscale of treatment effectiveness showed 36% of 49 eligible patients rating effectiveness as being worse than expected, 25% as expected, 37% better. 51% found side effects worse than expected, 19% as expected, and 28% better than expected. Textual analysis of survey responses indicated the majority of patients stood by their decision to take chemotherapy but wished they’d had more information about what to expect. Overall, 55% found chemotherapy to have been worthwhile, 37% not, 8% were undecided.

Limitations Accrual was slower than expected, in part because of a lack of awareness by patients that there were no further chemotherapy options available to them. Selection bias may have favored enrolment from teams open to soliciting patient feedback.

Conclusions Although the majority of patients stood by their decisions about palliative chemotherapy based on their understanding of the therapy at the time of making their decisions, there is a discrepancy between initial expectations about chemotherapy and retrospective assessment of chemotherapy effectiveness and side effects. The introduction of end-of-treatment feedback surveys as a routine quality assurance procedure should be considered.

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

Outpatient palliative care is increasingly delivered through co-management, a collaborative model of care that enables palliative care clinicians and oncologists to coordinate efforts. Here, we offer a distillation of our experience with co-management at a large teaching hospital. We describe three strategies to implement co-management: a shared understanding of each subspecialty, a shared framework to help patients cultivate prognostic awareness, and a shared vision for the clinical goals. We hope that this synthesis will foster the development of co-management.

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

Outpatient palliative care is increasingly delivered through co-management, a collaborative model of care that enables palliative care clinicians and oncologists to coordinate efforts. Here, we offer a distillation of our experience with co-management at a large teaching hospital. We describe three strategies to implement co-management: a shared understanding of each subspecialty, a shared framework to help patients cultivate prognostic awareness, and a shared vision for the clinical goals. We hope that this synthesis will foster the development of co-management.

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

Outpatient palliative care is increasingly delivered through co-management, a collaborative model of care that enables palliative care clinicians and oncologists to coordinate efforts. Here, we offer a distillation of our experience with co-management at a large teaching hospital. We describe three strategies to implement co-management: a shared understanding of each subspecialty, a shared framework to help patients cultivate prognostic awareness, and a shared vision for the clinical goals. We hope that this synthesis will foster the development of co-management.

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

We end this year with yet another encouraging list from the US Food and Drug Administration (FDA) of new drugs or expanded uses for some previously approved drugs for patients with life-threatening cancers. As clinicians focused on delivering quality, cost-effective care to our patients, that is exciting, but the overarching issues of dosing specificity, increasingly specific gene mutation testing, and complex therapy sequencing requirements explain another major trend of 2016: the increasing adoption of standardized pathways. In addition, given the continued explosion in drug pricing and the expanding use of high-cost drugs in more common diseases and in more lines of therapy, payers and providers are working to incorporate expanded decision support tools such as pathways to guide and optimally monitor therapies for patients.

Click on the PDF icon below to read the full article.

We end this year with yet another encouraging list from the US Food and Drug Administration (FDA) of new drugs or expanded uses for some previously approved drugs for patients with life-threatening cancers. As clinicians focused on delivering quality, cost-effective care to our patients, that is exciting, but the overarching issues of dosing specificity, increasingly specific gene mutation testing, and complex therapy sequencing requirements explain another major trend of 2016: the increasing adoption of standardized pathways. In addition, given the continued explosion in drug pricing and the expanding use of high-cost drugs in more common diseases and in more lines of therapy, payers and providers are working to incorporate expanded decision support tools such as pathways to guide and optimally monitor therapies for patients.

Click on the PDF icon below to read the full article.

We end this year with yet another encouraging list from the US Food and Drug Administration (FDA) of new drugs or expanded uses for some previously approved drugs for patients with life-threatening cancers. As clinicians focused on delivering quality, cost-effective care to our patients, that is exciting, but the overarching issues of dosing specificity, increasingly specific gene mutation testing, and complex therapy sequencing requirements explain another major trend of 2016: the increasing adoption of standardized pathways. In addition, given the continued explosion in drug pricing and the expanding use of high-cost drugs in more common diseases and in more lines of therapy, payers and providers are working to incorporate expanded decision support tools such as pathways to guide and optimally monitor therapies for patients.

Click on the PDF icon below to read the full article.

In the December podcast for The Journal of Community and Supportive Oncology, Dr David Henry discusses a round-up and review by Linda Bosserman, an Editor on the Journal, of the 2016 oncology landscape – from new therapy approvals, to practice pathways and value-based care, and the implementation of MACRA. Also included are Original Reports on patients’ retrospective assessment of palliative chemotherapy for lung or gastrointestinal cancers, social support needs among patients with advanced breast cancer, and quality of life after surgery for pleural malignant mesothelioma. As always, we focus on cutting edge care for the cancer patient, with two features, one by our regular contributor, Jane de Lartigue, who brings us up to date on new therapies for pancreatic cancer, and a second, practice-oriented article that reports on adopting a team approach for co-managing the clinical and palliative components in caring for our patients. Among the regular offerings, we have Case Reports on paraneoplastic Isaacs syndrome that led to diagnosis of small-cell lung cancer and unicentric Castleman disease that was disguised as a pancreatic neoplasm, and a Community Translations report on the approval of pembrolizumab as the first immune checkpoint inhibitor to receive approval for head and neck cancer.

Listen to the podcast below.

In the December podcast for The Journal of Community and Supportive Oncology, Dr David Henry discusses a round-up and review by Linda Bosserman, an Editor on the Journal, of the 2016 oncology landscape – from new therapy approvals, to practice pathways and value-based care, and the implementation of MACRA. Also included are Original Reports on patients’ retrospective assessment of palliative chemotherapy for lung or gastrointestinal cancers, social support needs among patients with advanced breast cancer, and quality of life after surgery for pleural malignant mesothelioma. As always, we focus on cutting edge care for the cancer patient, with two features, one by our regular contributor, Jane de Lartigue, who brings us up to date on new therapies for pancreatic cancer, and a second, practice-oriented article that reports on adopting a team approach for co-managing the clinical and palliative components in caring for our patients. Among the regular offerings, we have Case Reports on paraneoplastic Isaacs syndrome that led to diagnosis of small-cell lung cancer and unicentric Castleman disease that was disguised as a pancreatic neoplasm, and a Community Translations report on the approval of pembrolizumab as the first immune checkpoint inhibitor to receive approval for head and neck cancer.

Listen to the podcast below.

In the December podcast for The Journal of Community and Supportive Oncology, Dr David Henry discusses a round-up and review by Linda Bosserman, an Editor on the Journal, of the 2016 oncology landscape – from new therapy approvals, to practice pathways and value-based care, and the implementation of MACRA. Also included are Original Reports on patients’ retrospective assessment of palliative chemotherapy for lung or gastrointestinal cancers, social support needs among patients with advanced breast cancer, and quality of life after surgery for pleural malignant mesothelioma. As always, we focus on cutting edge care for the cancer patient, with two features, one by our regular contributor, Jane de Lartigue, who brings us up to date on new therapies for pancreatic cancer, and a second, practice-oriented article that reports on adopting a team approach for co-managing the clinical and palliative components in caring for our patients. Among the regular offerings, we have Case Reports on paraneoplastic Isaacs syndrome that led to diagnosis of small-cell lung cancer and unicentric Castleman disease that was disguised as a pancreatic neoplasm, and a Community Translations report on the approval of pembrolizumab as the first immune checkpoint inhibitor to receive approval for head and neck cancer.

Listen to the podcast below.

HIV-related lymphoma rate remains sky-high despite ART
Key clinical point ART has had a major impact on the incidence of HIV-related non-Hodgkin lymphoma but no effect on Hodgkin lymphoma. Major finding The overall incidence of non-Hodgkin lymphoma in HIV-positive adults on ART is 287 cases per 100,000 person-years, varying by location and route of HIV acquisition. Data source A longitudinal analysis of non-Hodgkin lymphoma incidence in more than 210,000 HIV-infected adults on combination ART on 4 continents. Disclosures The European Union and the National Institutes of Health. The presenter reported having no financial conflicts of interest.

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

HIV-related lymphoma rate remains sky-high despite ART
Key clinical point ART has had a major impact on the incidence of HIV-related non-Hodgkin lymphoma but no effect on Hodgkin lymphoma. Major finding The overall incidence of non-Hodgkin lymphoma in HIV-positive adults on ART is 287 cases per 100,000 person-years, varying by location and route of HIV acquisition. Data source A longitudinal analysis of non-Hodgkin lymphoma incidence in more than 210,000 HIV-infected adults on combination ART on 4 continents. Disclosures The European Union and the National Institutes of Health. The presenter reported having no financial conflicts of interest.

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

HIV-related lymphoma rate remains sky-high despite ART
Key clinical point ART has had a major impact on the incidence of HIV-related non-Hodgkin lymphoma but no effect on Hodgkin lymphoma. Major finding The overall incidence of non-Hodgkin lymphoma in HIV-positive adults on ART is 287 cases per 100,000 person-years, varying by location and route of HIV acquisition. Data source A longitudinal analysis of non-Hodgkin lymphoma incidence in more than 210,000 HIV-infected adults on combination ART on 4 continents. Disclosures The European Union and the National Institutes of Health. The presenter reported having no financial conflicts of interest.

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

Patients with head and neck squamous cell carcinoma typically present with dysphagia, odynophagia, and weight loss. Treatment of the disease with surgery or concurrent chemoradiation often results in local inflammation and limits further oral intake. Percutaneous endoscopic gastrostomy has been a common and effective means of nutritional support in these patients.

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

Patients with head and neck squamous cell carcinoma typically present with dysphagia, odynophagia, and weight loss. Treatment of the disease with surgery or concurrent chemoradiation often results in local inflammation and limits further oral intake. Percutaneous endoscopic gastrostomy has been a common and effective means of nutritional support in these patients.

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

Patients with head and neck squamous cell carcinoma typically present with dysphagia, odynophagia, and weight loss. Treatment of the disease with surgery or concurrent chemoradiation often results in local inflammation and limits further oral intake. Percutaneous endoscopic gastrostomy has been a common and effective means of nutritional support in these patients.

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

Acute myeloid leukemia (AML) is characterized by clonal proliferation of myeloid precursors with a reduced capacity to differentiate into mature cellular components.¹ Acute promyeloctic leukemia (APL; previously called AML-M3), a subtype of AML, is further characterized by a balanced translocation t(15;17) (q24.1;q21.1). It is an interesting model in cancer research because it responds to the differentiation and apoptosis induction therapy using arsenic trioxide (ATO) and all-trans retinoic acid (ATRA).²

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

Acute myeloid leukemia (AML) is characterized by clonal proliferation of myeloid precursors with a reduced capacity to differentiate into mature cellular components.¹ Acute promyeloctic leukemia (APL; previously called AML-M3), a subtype of AML, is further characterized by a balanced translocation t(15;17) (q24.1;q21.1). It is an interesting model in cancer research because it responds to the differentiation and apoptosis induction therapy using arsenic trioxide (ATO) and all-trans retinoic acid (ATRA).²

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

Acute myeloid leukemia (AML) is characterized by clonal proliferation of myeloid precursors with a reduced capacity to differentiate into mature cellular components.¹ Acute promyeloctic leukemia (APL; previously called AML-M3), a subtype of AML, is further characterized by a balanced translocation t(15;17) (q24.1;q21.1). It is an interesting model in cancer research because it responds to the differentiation and apoptosis induction therapy using arsenic trioxide (ATO) and all-trans retinoic acid (ATRA).²

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

Background Elderly cancer patients are a special population, and their management should include specialists in oncology, geriatrics, palliative care, and social work. Based on this approach, we designed a multidisciplinary care model (MCM) and prospectively assessed its results.

Objectives To evaluate the applicability of the MCM, to describe the geriatric features of our sample, and to assess the impact of the MCM on treatment choices.

Methods Patients older than 69 years of age with solid tumors were included. The MCM included the following decision algorithm: Patients with an unequivocal condition of frailty, assessed in the corresponding tumor committee, were directly referred to the palliative care team (Group A). In the other cases (Group B), patients over age 79 years underwent the Comprehensive Geriatric Assessment (CGA) and patients aged between 70 and 79 years completed a frailty test. If the frailty test was positive, CGA was also per formed.

Results 295 patients meeting the inclusion criteria were identified during one year. 186 (63%) were included in the MCM. A total of 66 CGA were performed. CGA modified the therapeutic plan in 5 patients older than 80 (13.8%), and in 2 septuagenarian patients (6.6%).

Limitations This study was designed to evaluate the feasibility of a multidisciplinary approach in geriatric oncology patients in a real clinical setting. Therefore, some variables were not fully controlled in the design, such as the willingness of different specialists to refer their patients to the model.

Conclusions MCM in elderly oncology patients is feasible in a general hospital, although several reasons often hinder patient recruitment for this kind of program. CGA can modify the therapeutic plan, especially in the octogenarian population.

Funding/sponsorship This study has been financially supported by a grant from the Fundació Joan Costa Romà. 

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

Background Elderly cancer patients are a special population, and their management should include specialists in oncology, geriatrics, palliative care, and social work. Based on this approach, we designed a multidisciplinary care model (MCM) and prospectively assessed its results.

Objectives To evaluate the applicability of the MCM, to describe the geriatric features of our sample, and to assess the impact of the MCM on treatment choices.

Methods Patients older than 69 years of age with solid tumors were included. The MCM included the following decision algorithm: Patients with an unequivocal condition of frailty, assessed in the corresponding tumor committee, were directly referred to the palliative care team (Group A). In the other cases (Group B), patients over age 79 years underwent the Comprehensive Geriatric Assessment (CGA) and patients aged between 70 and 79 years completed a frailty test. If the frailty test was positive, CGA was also per formed.

Results 295 patients meeting the inclusion criteria were identified during one year. 186 (63%) were included in the MCM. A total of 66 CGA were performed. CGA modified the therapeutic plan in 5 patients older than 80 (13.8%), and in 2 septuagenarian patients (6.6%).

Limitations This study was designed to evaluate the feasibility of a multidisciplinary approach in geriatric oncology patients in a real clinical setting. Therefore, some variables were not fully controlled in the design, such as the willingness of different specialists to refer their patients to the model.

Conclusions MCM in elderly oncology patients is feasible in a general hospital, although several reasons often hinder patient recruitment for this kind of program. CGA can modify the therapeutic plan, especially in the octogenarian population.

Funding/sponsorship This study has been financially supported by a grant from the Fundació Joan Costa Romà. 

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

Background Elderly cancer patients are a special population, and their management should include specialists in oncology, geriatrics, palliative care, and social work. Based on this approach, we designed a multidisciplinary care model (MCM) and prospectively assessed its results.

Objectives To evaluate the applicability of the MCM, to describe the geriatric features of our sample, and to assess the impact of the MCM on treatment choices.

Methods Patients older than 69 years of age with solid tumors were included. The MCM included the following decision algorithm: Patients with an unequivocal condition of frailty, assessed in the corresponding tumor committee, were directly referred to the palliative care team (Group A). In the other cases (Group B), patients over age 79 years underwent the Comprehensive Geriatric Assessment (CGA) and patients aged between 70 and 79 years completed a frailty test. If the frailty test was positive, CGA was also per formed.

Results 295 patients meeting the inclusion criteria were identified during one year. 186 (63%) were included in the MCM. A total of 66 CGA were performed. CGA modified the therapeutic plan in 5 patients older than 80 (13.8%), and in 2 septuagenarian patients (6.6%).

Limitations This study was designed to evaluate the feasibility of a multidisciplinary approach in geriatric oncology patients in a real clinical setting. Therefore, some variables were not fully controlled in the design, such as the willingness of different specialists to refer their patients to the model.

Conclusions MCM in elderly oncology patients is feasible in a general hospital, although several reasons often hinder patient recruitment for this kind of program. CGA can modify the therapeutic plan, especially in the octogenarian population.

Funding/sponsorship This study has been financially supported by a grant from the Fundació Joan Costa Romà. 

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

In the November podcast for The Journal of Community and Supportive Oncology, the Editor-in-Chief, Dr David Henry, presents an in-depth interview on myelodysplastic syndromes that he conducted with Dr David Steensma of the Dana-Farber Cancer Institute in Boston as well as a number of articles that focus on hematologic malignancies. The latter include Original Reports on using split-dose R-CHOP to administer cytotoxic chemo-immunotherapy to elderly patients with DLBCL and on outcomes of tumor lysis syndrome in pediatric patients with hematologic malignancies, a Case Report on acute-onset hypokalemic paralysis with arsenic trioxide therapy in patient with acute promyelocytic leukemia, and a Community Translations report on the approval of ofatumumab for patients with chronic lymphocytic leukemia. Also in the line-up are a review by JCSO Editor, Dr David Cella, about value-based cancer care from the patient perspective, and articles on multidisciplinary treatment planning in elderly patients with cancer and palliative concurrent chemoradiation for gastrostomy site metastasis.

Listen to the podcast below.

In the November podcast for The Journal of Community and Supportive Oncology, the Editor-in-Chief, Dr David Henry, presents an in-depth interview on myelodysplastic syndromes that he conducted with Dr David Steensma of the Dana-Farber Cancer Institute in Boston as well as a number of articles that focus on hematologic malignancies. The latter include Original Reports on using split-dose R-CHOP to administer cytotoxic chemo-immunotherapy to elderly patients with DLBCL and on outcomes of tumor lysis syndrome in pediatric patients with hematologic malignancies, a Case Report on acute-onset hypokalemic paralysis with arsenic trioxide therapy in patient with acute promyelocytic leukemia, and a Community Translations report on the approval of ofatumumab for patients with chronic lymphocytic leukemia. Also in the line-up are a review by JCSO Editor, Dr David Cella, about value-based cancer care from the patient perspective, and articles on multidisciplinary treatment planning in elderly patients with cancer and palliative concurrent chemoradiation for gastrostomy site metastasis.

Listen to the podcast below.

In the November podcast for The Journal of Community and Supportive Oncology, the Editor-in-Chief, Dr David Henry, presents an in-depth interview on myelodysplastic syndromes that he conducted with Dr David Steensma of the Dana-Farber Cancer Institute in Boston as well as a number of articles that focus on hematologic malignancies. The latter include Original Reports on using split-dose R-CHOP to administer cytotoxic chemo-immunotherapy to elderly patients with DLBCL and on outcomes of tumor lysis syndrome in pediatric patients with hematologic malignancies, a Case Report on acute-onset hypokalemic paralysis with arsenic trioxide therapy in patient with acute promyelocytic leukemia, and a Community Translations report on the approval of ofatumumab for patients with chronic lymphocytic leukemia. Also in the line-up are a review by JCSO Editor, Dr David Cella, about value-based cancer care from the patient perspective, and articles on multidisciplinary treatment planning in elderly patients with cancer and palliative concurrent chemoradiation for gastrostomy site metastasis.

Listen to the podcast below.

Background Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma. It is challenging to deliver standard rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) chemotherapy in the very elderly or elderly with comorbidities because of age-related changes in metabolism and performance.

Objectives To describe outcomes of a unique approach to the delivery of standard R-CHOP chemotherapy in split-doses for the treatment of elderly DLBCL patients.

Methods We performed a single center, retrospective analysis of all patients with DLBCL treated with split-dose R-CHOP during January 2007-April 2015. The patients received R-CHOP at a 50% dose reduction on days 1 and 15 of each 28-day cycle (split dose), with full dose rituximab on day 1 for up to 6 cycles. The total amount of chemotherapy delivered during each 28-day cycle of split-dose R-CHOP was equivalent to the cumulative dose in each 21-day cycle of standard R-CHOP.

Results We identified 22 patients who had been treated with split-dose R-CHOP (median age, 81 years). 10 patients had a Charlson Comorbidity Index score of 2 or more, and 13 were aged 80 or older. 12 patients completed their prescribed treatments, and 10 required further de-escalation or early termination owing to toxicity. All of the patients who completed therapy were in a complete remission at the end of treatment. The median overall survival for the entire cohort was 47 months, and median progression-free survival was 43 months.

Limitations Retrospective, single institution study, small cohort Conclusions Split-dose R-CHOP allowed administration of curative-intent therapy in an elderly population with encouraging outcomes.

Conclusions Split-dose R-CHOP allowed administration of curative-intent therapy in an elderly population with encouraging outcomes.

Funding/sponsorship Cancer Center Research Training Program, NCI 5-T32 CA09615-25 (fellowship funding for Dr Shah).
 

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

Background Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma. It is challenging to deliver standard rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) chemotherapy in the very elderly or elderly with comorbidities because of age-related changes in metabolism and performance.

Objectives To describe outcomes of a unique approach to the delivery of standard R-CHOP chemotherapy in split-doses for the treatment of elderly DLBCL patients.

Methods We performed a single center, retrospective analysis of all patients with DLBCL treated with split-dose R-CHOP during January 2007-April 2015. The patients received R-CHOP at a 50% dose reduction on days 1 and 15 of each 28-day cycle (split dose), with full dose rituximab on day 1 for up to 6 cycles. The total amount of chemotherapy delivered during each 28-day cycle of split-dose R-CHOP was equivalent to the cumulative dose in each 21-day cycle of standard R-CHOP.

Results We identified 22 patients who had been treated with split-dose R-CHOP (median age, 81 years). 10 patients had a Charlson Comorbidity Index score of 2 or more, and 13 were aged 80 or older. 12 patients completed their prescribed treatments, and 10 required further de-escalation or early termination owing to toxicity. All of the patients who completed therapy were in a complete remission at the end of treatment. The median overall survival for the entire cohort was 47 months, and median progression-free survival was 43 months.

Limitations Retrospective, single institution study, small cohort Conclusions Split-dose R-CHOP allowed administration of curative-intent therapy in an elderly population with encouraging outcomes.

Conclusions Split-dose R-CHOP allowed administration of curative-intent therapy in an elderly population with encouraging outcomes.

Funding/sponsorship Cancer Center Research Training Program, NCI 5-T32 CA09615-25 (fellowship funding for Dr Shah).
 

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

Background Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma. It is challenging to deliver standard rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) chemotherapy in the very elderly or elderly with comorbidities because of age-related changes in metabolism and performance.

Objectives To describe outcomes of a unique approach to the delivery of standard R-CHOP chemotherapy in split-doses for the treatment of elderly DLBCL patients.

Methods We performed a single center, retrospective analysis of all patients with DLBCL treated with split-dose R-CHOP during January 2007-April 2015. The patients received R-CHOP at a 50% dose reduction on days 1 and 15 of each 28-day cycle (split dose), with full dose rituximab on day 1 for up to 6 cycles. The total amount of chemotherapy delivered during each 28-day cycle of split-dose R-CHOP was equivalent to the cumulative dose in each 21-day cycle of standard R-CHOP.

Results We identified 22 patients who had been treated with split-dose R-CHOP (median age, 81 years). 10 patients had a Charlson Comorbidity Index score of 2 or more, and 13 were aged 80 or older. 12 patients completed their prescribed treatments, and 10 required further de-escalation or early termination owing to toxicity. All of the patients who completed therapy were in a complete remission at the end of treatment. The median overall survival for the entire cohort was 47 months, and median progression-free survival was 43 months.

Limitations Retrospective, single institution study, small cohort Conclusions Split-dose R-CHOP allowed administration of curative-intent therapy in an elderly population with encouraging outcomes.

Conclusions Split-dose R-CHOP allowed administration of curative-intent therapy in an elderly population with encouraging outcomes.

Funding/sponsorship Cancer Center Research Training Program, NCI 5-T32 CA09615-25 (fellowship funding for Dr Shah).
 

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