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Research and Reviews for the Practicing Oncologist
Oral anticancer therapy: a comprehensive assessment of patient perceptions and challenges
Background Oral anticancer agents are more convenient to use and better tolerated than traditional intravenous therapy but come with significant concerns about patient noncompliance, adverse effects, and high cost. Identifying areas for improvement in the medication use process may help ensure optimal use of these agents.
Methods 30 patients who were receiving oral anticancer therapy were administered a brief survey during their visits to an ambulatory Department of Veterans’ Affairs oncology clinic where pharmacists are heavily involved in providing initial and follow-up medication use education. Veterans aged 18 years or older were considered for inclusion into the study if they were currently being treated with an oral anticancer medication from a specified list for at least 1 month. Topics addressed included drug information sources, regimen compliance, management of side effects, and cost. The results were results were analyzed using univariate descriptive statistics.
Results Most of the patients were satisfied with their oral treatment, reporting ease of use with minimal side effect occurrence. Oncologists and pharmacists were equally named as sources of drug information.
Limitations Sample size was small and patients were overwhelmingly male. Response bias may be partially responsible for the observed results for regimen management, side effect occurrence, missed doses, and overall treatment satisfaction.
Conclusion Oral anticancer therapy represents a significant therapeutic advance for many types of cancer. Pharmacists can serve as vital informational resources to these patients. Further studies examining the role of pharmacist-led educational programs in terms of overall patient outcomes are warranted.
Background Oral anticancer agents are more convenient to use and better tolerated than traditional intravenous therapy but come with significant concerns about patient noncompliance, adverse effects, and high cost. Identifying areas for improvement in the medication use process may help ensure optimal use of these agents.
Methods 30 patients who were receiving oral anticancer therapy were administered a brief survey during their visits to an ambulatory Department of Veterans’ Affairs oncology clinic where pharmacists are heavily involved in providing initial and follow-up medication use education. Veterans aged 18 years or older were considered for inclusion into the study if they were currently being treated with an oral anticancer medication from a specified list for at least 1 month. Topics addressed included drug information sources, regimen compliance, management of side effects, and cost. The results were results were analyzed using univariate descriptive statistics.
Results Most of the patients were satisfied with their oral treatment, reporting ease of use with minimal side effect occurrence. Oncologists and pharmacists were equally named as sources of drug information.
Limitations Sample size was small and patients were overwhelmingly male. Response bias may be partially responsible for the observed results for regimen management, side effect occurrence, missed doses, and overall treatment satisfaction.
Conclusion Oral anticancer therapy represents a significant therapeutic advance for many types of cancer. Pharmacists can serve as vital informational resources to these patients. Further studies examining the role of pharmacist-led educational programs in terms of overall patient outcomes are warranted.
Background Oral anticancer agents are more convenient to use and better tolerated than traditional intravenous therapy but come with significant concerns about patient noncompliance, adverse effects, and high cost. Identifying areas for improvement in the medication use process may help ensure optimal use of these agents.
Methods 30 patients who were receiving oral anticancer therapy were administered a brief survey during their visits to an ambulatory Department of Veterans’ Affairs oncology clinic where pharmacists are heavily involved in providing initial and follow-up medication use education. Veterans aged 18 years or older were considered for inclusion into the study if they were currently being treated with an oral anticancer medication from a specified list for at least 1 month. Topics addressed included drug information sources, regimen compliance, management of side effects, and cost. The results were results were analyzed using univariate descriptive statistics.
Results Most of the patients were satisfied with their oral treatment, reporting ease of use with minimal side effect occurrence. Oncologists and pharmacists were equally named as sources of drug information.
Limitations Sample size was small and patients were overwhelmingly male. Response bias may be partially responsible for the observed results for regimen management, side effect occurrence, missed doses, and overall treatment satisfaction.
Conclusion Oral anticancer therapy represents a significant therapeutic advance for many types of cancer. Pharmacists can serve as vital informational resources to these patients. Further studies examining the role of pharmacist-led educational programs in terms of overall patient outcomes are warranted.
Impact of trimodality treatment on patient quality of life and arm function for superior sulcus tumors
Background Trimodality treatment leads to improved survival for superior sulcus tumor (SST) patients. Not much is known about the impact of this treatment on arm function and patient quality of life.
Objective To analyze arm function and quality of life in SST patients undergoing trimodality treatment.
Methods This was a prospective cohort study of consecutive SST patients treated with trimodality treatment that was conducted between April 1, 2010 and October 31, 2012. We obtained informed consent for 20 of 22 eligible patients. The 36-item Short Form Health Survey (SF-36) and disabilities of the arm, shoulder, and hand (DASH) questionnaires were used to asses patient quality of life and subjective arm function at 0 (preoperative day), 3, and 12 months after trimodality treatment.
Results DASH scores were significantly lower at 3 and 12 months (P = .024 and P = .011) compared with preoperative scores. Significantly lower scores were reported for the SF-36 domains of physical functioning at 12 months (P = .020) and of physical role functioning at 3 months (P = .041), and significantly more pain was reported at 3 and 12 months (P = .006 and P = .019, respectively). Patients who underwent T1 nerve root resection had lower scores for the SF-36 domain health change at 3 months (P = .037) compared with those in whom the T1 root was spared. For all other domains no differences were found.
Limitations Small sample size; patient pre-chemoradiation function and quality of life unknown.
Conclusion Subjective arm function and patient quality of life is reduced following trimodality treatment. Resection of the T1 nerve root has no significant long-term effect on the subjective arm function and quality of life.
Click on the PDF icon at the top of this introduction to read the full article.
Background Trimodality treatment leads to improved survival for superior sulcus tumor (SST) patients. Not much is known about the impact of this treatment on arm function and patient quality of life.
Objective To analyze arm function and quality of life in SST patients undergoing trimodality treatment.
Methods This was a prospective cohort study of consecutive SST patients treated with trimodality treatment that was conducted between April 1, 2010 and October 31, 2012. We obtained informed consent for 20 of 22 eligible patients. The 36-item Short Form Health Survey (SF-36) and disabilities of the arm, shoulder, and hand (DASH) questionnaires were used to asses patient quality of life and subjective arm function at 0 (preoperative day), 3, and 12 months after trimodality treatment.
Results DASH scores were significantly lower at 3 and 12 months (P = .024 and P = .011) compared with preoperative scores. Significantly lower scores were reported for the SF-36 domains of physical functioning at 12 months (P = .020) and of physical role functioning at 3 months (P = .041), and significantly more pain was reported at 3 and 12 months (P = .006 and P = .019, respectively). Patients who underwent T1 nerve root resection had lower scores for the SF-36 domain health change at 3 months (P = .037) compared with those in whom the T1 root was spared. For all other domains no differences were found.
Limitations Small sample size; patient pre-chemoradiation function and quality of life unknown.
Conclusion Subjective arm function and patient quality of life is reduced following trimodality treatment. Resection of the T1 nerve root has no significant long-term effect on the subjective arm function and quality of life.
Click on the PDF icon at the top of this introduction to read the full article.
Background Trimodality treatment leads to improved survival for superior sulcus tumor (SST) patients. Not much is known about the impact of this treatment on arm function and patient quality of life.
Objective To analyze arm function and quality of life in SST patients undergoing trimodality treatment.
Methods This was a prospective cohort study of consecutive SST patients treated with trimodality treatment that was conducted between April 1, 2010 and October 31, 2012. We obtained informed consent for 20 of 22 eligible patients. The 36-item Short Form Health Survey (SF-36) and disabilities of the arm, shoulder, and hand (DASH) questionnaires were used to asses patient quality of life and subjective arm function at 0 (preoperative day), 3, and 12 months after trimodality treatment.
Results DASH scores were significantly lower at 3 and 12 months (P = .024 and P = .011) compared with preoperative scores. Significantly lower scores were reported for the SF-36 domains of physical functioning at 12 months (P = .020) and of physical role functioning at 3 months (P = .041), and significantly more pain was reported at 3 and 12 months (P = .006 and P = .019, respectively). Patients who underwent T1 nerve root resection had lower scores for the SF-36 domain health change at 3 months (P = .037) compared with those in whom the T1 root was spared. For all other domains no differences were found.
Limitations Small sample size; patient pre-chemoradiation function and quality of life unknown.
Conclusion Subjective arm function and patient quality of life is reduced following trimodality treatment. Resection of the T1 nerve root has no significant long-term effect on the subjective arm function and quality of life.
Click on the PDF icon at the top of this introduction to read the full article.
Financial toxicity in cancer care
The cost of cancer care is increasing, with important implications for the delivery of high-quality, patient-centered care. In the clinical setting, patients and physicians express a desire to discuss out-of-pocket costs. Nevertheless, both groups feel inadequately prepared to participate in these discussions, and perhaps not surprisingly, the integration of these discussions into clinical practice seems to be the exception rather than the rule.
Click on the PDF icon at the top of this introduction to read the full article.
The cost of cancer care is increasing, with important implications for the delivery of high-quality, patient-centered care. In the clinical setting, patients and physicians express a desire to discuss out-of-pocket costs. Nevertheless, both groups feel inadequately prepared to participate in these discussions, and perhaps not surprisingly, the integration of these discussions into clinical practice seems to be the exception rather than the rule.
Click on the PDF icon at the top of this introduction to read the full article.
The cost of cancer care is increasing, with important implications for the delivery of high-quality, patient-centered care. In the clinical setting, patients and physicians express a desire to discuss out-of-pocket costs. Nevertheless, both groups feel inadequately prepared to participate in these discussions, and perhaps not surprisingly, the integration of these discussions into clinical practice seems to be the exception rather than the rule.
Click on the PDF icon at the top of this introduction to read the full article.
Opioid risk assessment in palliative medicine
Pain management with opioids is an integral part of palliative medicine. As the doses and durations of opioid therapy increase, the inherent risks of opioid therapy rise. Although opioids are effective analgesics, they bring with them complex medical and psychological side effects. Aberrant behavior is dangerous and can be difficult to identify as it results in a splitting in the goals of treatment between the patient and providers. One effective strategy in preventing that situation is through the early identification of at-risk patients.
Click on the PDF icon at the top of this introduction to read the full article.
Pain management with opioids is an integral part of palliative medicine. As the doses and durations of opioid therapy increase, the inherent risks of opioid therapy rise. Although opioids are effective analgesics, they bring with them complex medical and psychological side effects. Aberrant behavior is dangerous and can be difficult to identify as it results in a splitting in the goals of treatment between the patient and providers. One effective strategy in preventing that situation is through the early identification of at-risk patients.
Click on the PDF icon at the top of this introduction to read the full article.
Pain management with opioids is an integral part of palliative medicine. As the doses and durations of opioid therapy increase, the inherent risks of opioid therapy rise. Although opioids are effective analgesics, they bring with them complex medical and psychological side effects. Aberrant behavior is dangerous and can be difficult to identify as it results in a splitting in the goals of treatment between the patient and providers. One effective strategy in preventing that situation is through the early identification of at-risk patients.
Click on the PDF icon at the top of this introduction to read the full article.
Encapsulated irinotecan provides novel option for hard-to-treat pancreatic cancer
In the fall of 2015, the US Food and Drug Administration approved the addition of a novel, much-needed treatment option for patients with metastatic pancreatic cancer, a particularly hard-to-treat form of the disease, in the second-line setting following progression on gemcitabine- based chemotherapy.1 MM-398 is a modified version of the chemotherapeutic agent irinotecan, in which the drug is encapsulated in a nanoliposomal construct that is designed to improve delivery to the tumor and enhance anti-tumor efficacy while minimizing side effects in the rest of the body.
Click on the PDF icon at the top of this introduction to read the full article.
In the fall of 2015, the US Food and Drug Administration approved the addition of a novel, much-needed treatment option for patients with metastatic pancreatic cancer, a particularly hard-to-treat form of the disease, in the second-line setting following progression on gemcitabine- based chemotherapy.1 MM-398 is a modified version of the chemotherapeutic agent irinotecan, in which the drug is encapsulated in a nanoliposomal construct that is designed to improve delivery to the tumor and enhance anti-tumor efficacy while minimizing side effects in the rest of the body.
Click on the PDF icon at the top of this introduction to read the full article.
In the fall of 2015, the US Food and Drug Administration approved the addition of a novel, much-needed treatment option for patients with metastatic pancreatic cancer, a particularly hard-to-treat form of the disease, in the second-line setting following progression on gemcitabine- based chemotherapy.1 MM-398 is a modified version of the chemotherapeutic agent irinotecan, in which the drug is encapsulated in a nanoliposomal construct that is designed to improve delivery to the tumor and enhance anti-tumor efficacy while minimizing side effects in the rest of the body.
Click on the PDF icon at the top of this introduction to read the full article.
Approvals and presentations flag notable advances in the hem-onc space
Scientific advances and their translation from bench to bedside were front and foremost in the hematology-oncology sphere during 2015 and were bolstered by a record number of therapy approvals by the US Food and Drug Administration (FDA).1 The most recent of those approvals included elotuzumab and ixazomib (both with lenalidomide plus dexamethasone) for previously treated patients with multiple myeloma; and daratumumab as a single agent, also for previously treated multiple myeloma.
Click on the PDF icon at the top of this introduction to read the full article.
Scientific advances and their translation from bench to bedside were front and foremost in the hematology-oncology sphere during 2015 and were bolstered by a record number of therapy approvals by the US Food and Drug Administration (FDA).1 The most recent of those approvals included elotuzumab and ixazomib (both with lenalidomide plus dexamethasone) for previously treated patients with multiple myeloma; and daratumumab as a single agent, also for previously treated multiple myeloma.
Click on the PDF icon at the top of this introduction to read the full article.
Scientific advances and their translation from bench to bedside were front and foremost in the hematology-oncology sphere during 2015 and were bolstered by a record number of therapy approvals by the US Food and Drug Administration (FDA).1 The most recent of those approvals included elotuzumab and ixazomib (both with lenalidomide plus dexamethasone) for previously treated patients with multiple myeloma; and daratumumab as a single agent, also for previously treated multiple myeloma.
Click on the PDF icon at the top of this introduction to read the full article.
David Henry's JCSO podcast, February 2016
For the February podcast for The Journal of Community and Supportive Oncology, Editor-in-Chief Dr David Henry examines two Original Reports, one on a collaborative investigation by scientists and members of a social network into fluoroquinolone-related neuropsychiatric and mitochondrial toxicity and another on the prognostic value of complete remission with superior platelet counts in patients with acute myeloid leukemia. The Case Reports this month focus on rare tumors: in one case, it is a metastatic primary bladder adenocarcinoma for which a novel treatment approach prolonged survival; and in a second, an 18-year follow-up on a rare, indolent form of T-cell prolymphocytic leukemia. The Community Translations column features the novel MEK inhibitor, cobimetinib, which was approved last year in combination with the BRAF inhibitor, vemurafenib, for metastatic melanoma with BRAF V600E or V600K mutation. Dr Henry also discusses articles on new therapies for gastrointestinal cancers and on selected practice-changing presentations from the 2015 annual meeting of the San Antonio Breast Cancer Symposium in Orlando last year.
Listen to the podcast below.
For the February podcast for The Journal of Community and Supportive Oncology, Editor-in-Chief Dr David Henry examines two Original Reports, one on a collaborative investigation by scientists and members of a social network into fluoroquinolone-related neuropsychiatric and mitochondrial toxicity and another on the prognostic value of complete remission with superior platelet counts in patients with acute myeloid leukemia. The Case Reports this month focus on rare tumors: in one case, it is a metastatic primary bladder adenocarcinoma for which a novel treatment approach prolonged survival; and in a second, an 18-year follow-up on a rare, indolent form of T-cell prolymphocytic leukemia. The Community Translations column features the novel MEK inhibitor, cobimetinib, which was approved last year in combination with the BRAF inhibitor, vemurafenib, for metastatic melanoma with BRAF V600E or V600K mutation. Dr Henry also discusses articles on new therapies for gastrointestinal cancers and on selected practice-changing presentations from the 2015 annual meeting of the San Antonio Breast Cancer Symposium in Orlando last year.
Listen to the podcast below.
For the February podcast for The Journal of Community and Supportive Oncology, Editor-in-Chief Dr David Henry examines two Original Reports, one on a collaborative investigation by scientists and members of a social network into fluoroquinolone-related neuropsychiatric and mitochondrial toxicity and another on the prognostic value of complete remission with superior platelet counts in patients with acute myeloid leukemia. The Case Reports this month focus on rare tumors: in one case, it is a metastatic primary bladder adenocarcinoma for which a novel treatment approach prolonged survival; and in a second, an 18-year follow-up on a rare, indolent form of T-cell prolymphocytic leukemia. The Community Translations column features the novel MEK inhibitor, cobimetinib, which was approved last year in combination with the BRAF inhibitor, vemurafenib, for metastatic melanoma with BRAF V600E or V600K mutation. Dr Henry also discusses articles on new therapies for gastrointestinal cancers and on selected practice-changing presentations from the 2015 annual meeting of the San Antonio Breast Cancer Symposium in Orlando last year.
Listen to the podcast below.
Encouraging data on immunotherapy, cardiotoxicity, and DFS
Click on the PDF icon at the top of this introduction to read the full article.
Click on the PDF icon at the top of this introduction to read the full article.
Click on the PDF icon at the top of this introduction to read the full article.
New GI therapies bring hope after much frustration
Click on the PDF icon at the top of this introduction to read the full article.
Click on the PDF icon at the top of this introduction to read the full article.
Click on the PDF icon at the top of this introduction to read the full article.
An extremely indolent T-cell leukemia: an 18-year follow-up
T-cell prolymphocytic leukemia (T-PLL) is a rare malignancy that comprises about 2% of all mature lymphoid neoplasms. Patients usually present with prominent peripheral blood lymphocytosis, splenomegaly, hepatomegaly, lymphadenopathy, B symptoms, and occasionally with skin lesions.1 The disease follows an aggressive clinical course with rapid progression and typically has a median survival of less than 1 year. In some cases, the disease is indolent for a period of time before becoming aggressive.2 In 2002, 7 years after initial diagnosis in 1995, the case discussed herein was reported as a rare, indolent form of T-PLL.3 We now present 11 additional years of follow-up of this case, during which time the patient remained asymptomatic with respect to his lymphoid neoplasm.
Click on the PDF icon at the top of this introduction to read the full article.
T-cell prolymphocytic leukemia (T-PLL) is a rare malignancy that comprises about 2% of all mature lymphoid neoplasms. Patients usually present with prominent peripheral blood lymphocytosis, splenomegaly, hepatomegaly, lymphadenopathy, B symptoms, and occasionally with skin lesions.1 The disease follows an aggressive clinical course with rapid progression and typically has a median survival of less than 1 year. In some cases, the disease is indolent for a period of time before becoming aggressive.2 In 2002, 7 years after initial diagnosis in 1995, the case discussed herein was reported as a rare, indolent form of T-PLL.3 We now present 11 additional years of follow-up of this case, during which time the patient remained asymptomatic with respect to his lymphoid neoplasm.
Click on the PDF icon at the top of this introduction to read the full article.
T-cell prolymphocytic leukemia (T-PLL) is a rare malignancy that comprises about 2% of all mature lymphoid neoplasms. Patients usually present with prominent peripheral blood lymphocytosis, splenomegaly, hepatomegaly, lymphadenopathy, B symptoms, and occasionally with skin lesions.1 The disease follows an aggressive clinical course with rapid progression and typically has a median survival of less than 1 year. In some cases, the disease is indolent for a period of time before becoming aggressive.2 In 2002, 7 years after initial diagnosis in 1995, the case discussed herein was reported as a rare, indolent form of T-PLL.3 We now present 11 additional years of follow-up of this case, during which time the patient remained asymptomatic with respect to his lymphoid neoplasm.
Click on the PDF icon at the top of this introduction to read the full article.