User login
Congestive heart failure during induction with anthracycline-based therapy in patients with acute promyelocytic leukemia
Background Acute promyelocytic leukemia (APL) is a highly curable malignancy. However, 30% of patients die during therapy induction from bleeding, differentiation syndrome (DS), and/or infection. Recommendations suggest that congestive heart failure (CHF) is a presenting feature of DS.
Objective To assess the incidence of CHF during induction in patients with APL.
Methods A retrospective chart review was performed of patients diagnosed with APL from December 2004 to July 2013 and managed at Georgia Regents University Cancer Center. Baseline and follow-up ejection fractions (EF) were recorded and patients with a drop in EF during the induction period were evaluated.
Results Of the 40 evaluable patients, 37 received idarubicin-based chemotherapy. 16 of the 37 patients had a repeat ECHO for suspected cardiomyopathy, and 6 of the 16 patients (37.5%) demonstrated a decrease in EF (absolute drop, 10%-35%). The cardiac function recovered completely in 4 patients and partially in 1 patient. Gender, history of hypertension, and body mass index did not seem to correlate with incidence of CHF.
Limitations The patient population is very small given the rarity of the disease. Present practice patterns do not routinely address CHF in the differential diagnosis.
Conclusions Patients with APL are at risk for cardiac toxicity for a number of reasons, including cytokine storm and inflammatory state, use of anthracyclines, and DS. The clinical presentation of DS most commonly involves dyspnea and fluid retention, which are also symptoms of heart failure. Prompt cardiac evaluation should be undertaken to rule out CHF in APL patients who are going to receive an anthracycline-based therapy, because early intervention may result in an improved outcome.
Click on the PDF icon at the top of this introduction to read the full article.
Background Acute promyelocytic leukemia (APL) is a highly curable malignancy. However, 30% of patients die during therapy induction from bleeding, differentiation syndrome (DS), and/or infection. Recommendations suggest that congestive heart failure (CHF) is a presenting feature of DS.
Objective To assess the incidence of CHF during induction in patients with APL.
Methods A retrospective chart review was performed of patients diagnosed with APL from December 2004 to July 2013 and managed at Georgia Regents University Cancer Center. Baseline and follow-up ejection fractions (EF) were recorded and patients with a drop in EF during the induction period were evaluated.
Results Of the 40 evaluable patients, 37 received idarubicin-based chemotherapy. 16 of the 37 patients had a repeat ECHO for suspected cardiomyopathy, and 6 of the 16 patients (37.5%) demonstrated a decrease in EF (absolute drop, 10%-35%). The cardiac function recovered completely in 4 patients and partially in 1 patient. Gender, history of hypertension, and body mass index did not seem to correlate with incidence of CHF.
Limitations The patient population is very small given the rarity of the disease. Present practice patterns do not routinely address CHF in the differential diagnosis.
Conclusions Patients with APL are at risk for cardiac toxicity for a number of reasons, including cytokine storm and inflammatory state, use of anthracyclines, and DS. The clinical presentation of DS most commonly involves dyspnea and fluid retention, which are also symptoms of heart failure. Prompt cardiac evaluation should be undertaken to rule out CHF in APL patients who are going to receive an anthracycline-based therapy, because early intervention may result in an improved outcome.
Click on the PDF icon at the top of this introduction to read the full article.
Background Acute promyelocytic leukemia (APL) is a highly curable malignancy. However, 30% of patients die during therapy induction from bleeding, differentiation syndrome (DS), and/or infection. Recommendations suggest that congestive heart failure (CHF) is a presenting feature of DS.
Objective To assess the incidence of CHF during induction in patients with APL.
Methods A retrospective chart review was performed of patients diagnosed with APL from December 2004 to July 2013 and managed at Georgia Regents University Cancer Center. Baseline and follow-up ejection fractions (EF) were recorded and patients with a drop in EF during the induction period were evaluated.
Results Of the 40 evaluable patients, 37 received idarubicin-based chemotherapy. 16 of the 37 patients had a repeat ECHO for suspected cardiomyopathy, and 6 of the 16 patients (37.5%) demonstrated a decrease in EF (absolute drop, 10%-35%). The cardiac function recovered completely in 4 patients and partially in 1 patient. Gender, history of hypertension, and body mass index did not seem to correlate with incidence of CHF.
Limitations The patient population is very small given the rarity of the disease. Present practice patterns do not routinely address CHF in the differential diagnosis.
Conclusions Patients with APL are at risk for cardiac toxicity for a number of reasons, including cytokine storm and inflammatory state, use of anthracyclines, and DS. The clinical presentation of DS most commonly involves dyspnea and fluid retention, which are also symptoms of heart failure. Prompt cardiac evaluation should be undertaken to rule out CHF in APL patients who are going to receive an anthracycline-based therapy, because early intervention may result in an improved outcome.
Click on the PDF icon at the top of this introduction to read the full article.
Patient and provider concordance on symptoms during the oncology outpatient clinic visit
Objective To address gaps in previous research by prospectively examining concordance between HCPs and patients on identifying patients’ symptoms by using an identical tool for patients and HCPs at the time of the oncology clinic visit.
Methods 94 patients completed measures of symptom experience and medical comorbidities before seeing their oncology medical team. HCPs were informed of a patient’s participation in the study before seeing the patient in clinic. Immediately after the clinic visit, HCPs completed a symptom survey in which they noted the patient’s symptoms.
Results Patients reported more symptoms than the HCPs endorsed. The highest level of concordance for any symptom fell in the moderate agreement range. Kappa values reflecting concordance between patients and HCPs were not significantly different between the various patient-HCP pairs. No demographic or clinical variables for patients were found to be statistically related to the level of agreement on patients’ symptoms.
Limitations The use of a small convenience sample size drawn from 3 specialty oncology outpatient clinics may limit the generalizability of the results to other types of cancer. The distribution of cancer stage was weighted toward stages III and IV, likely contributing to the number of symptoms.
Conclusions The level of agreement between HCPs and oncology patients on patient symptoms is weak. Concordance levels were similar, regardless of the type of HCP.
Funding Siteman Cancer Center Summer Student Program.
Click on the PDF icon at the top of this introduction to read the full article.
Objective To address gaps in previous research by prospectively examining concordance between HCPs and patients on identifying patients’ symptoms by using an identical tool for patients and HCPs at the time of the oncology clinic visit.
Methods 94 patients completed measures of symptom experience and medical comorbidities before seeing their oncology medical team. HCPs were informed of a patient’s participation in the study before seeing the patient in clinic. Immediately after the clinic visit, HCPs completed a symptom survey in which they noted the patient’s symptoms.
Results Patients reported more symptoms than the HCPs endorsed. The highest level of concordance for any symptom fell in the moderate agreement range. Kappa values reflecting concordance between patients and HCPs were not significantly different between the various patient-HCP pairs. No demographic or clinical variables for patients were found to be statistically related to the level of agreement on patients’ symptoms.
Limitations The use of a small convenience sample size drawn from 3 specialty oncology outpatient clinics may limit the generalizability of the results to other types of cancer. The distribution of cancer stage was weighted toward stages III and IV, likely contributing to the number of symptoms.
Conclusions The level of agreement between HCPs and oncology patients on patient symptoms is weak. Concordance levels were similar, regardless of the type of HCP.
Funding Siteman Cancer Center Summer Student Program.
Click on the PDF icon at the top of this introduction to read the full article.
Objective To address gaps in previous research by prospectively examining concordance between HCPs and patients on identifying patients’ symptoms by using an identical tool for patients and HCPs at the time of the oncology clinic visit.
Methods 94 patients completed measures of symptom experience and medical comorbidities before seeing their oncology medical team. HCPs were informed of a patient’s participation in the study before seeing the patient in clinic. Immediately after the clinic visit, HCPs completed a symptom survey in which they noted the patient’s symptoms.
Results Patients reported more symptoms than the HCPs endorsed. The highest level of concordance for any symptom fell in the moderate agreement range. Kappa values reflecting concordance between patients and HCPs were not significantly different between the various patient-HCP pairs. No demographic or clinical variables for patients were found to be statistically related to the level of agreement on patients’ symptoms.
Limitations The use of a small convenience sample size drawn from 3 specialty oncology outpatient clinics may limit the generalizability of the results to other types of cancer. The distribution of cancer stage was weighted toward stages III and IV, likely contributing to the number of symptoms.
Conclusions The level of agreement between HCPs and oncology patients on patient symptoms is weak. Concordance levels were similar, regardless of the type of HCP.
Funding Siteman Cancer Center Summer Student Program.
Click on the PDF icon at the top of this introduction to read the full article.
Quality of supportive care for patients with advanced lung cancer in the Veterans Health Administration
Background Morbidity related to cancer and its treatment remains a significant source of human suffering and a challenge to the delivery of high-quality care.
Objective To develop and apply quality indicators to evaluate quality of supportive care for advanced lung cancer in the Veterans Health Administration (VHA) and examine facility-level predictors of quality.
Methods We evaluated supportive care quality using 12 quality indicators. Data were taken from VHA electronic health records for incident lung cancer cases occurring during 2007. Organizational characteristics of 111 VHA facilities were examined for association with receipt of care.
Results Rates of care-receipt were high, especially in the treatment toxicity (89%) and pain management (79%-98%) domains, but were lower in the palliative cancer treatment (60%-90%) and hospice (75%) domains, with substantial facility- level variation. Presence of a care tracking method that was monitored by a midlevel practitioner seemed to be associated with better quality for treatment toxicity (OR, 3.38; 95% CI, 1.87-6.10) and referral to hospice (OR, 1.60; 95% CI, 1.22-2.28); having a psychologist for cancer patients was associated with higher odds for pain management (OR, 1.76; 95% CI, 1.16-2.66).
Limitations Not all supportive care was evaluated. Care processes identified as present at facilities may not have been applied to cohort patients. Facility-level results may be influenced by errors in attributing a patient’s care to the correct facility.
Conclusions Quality indicators for supportive cancer care can be developed and applied in large evaluations using electronic health record review. This study confirmed high-quality supportive care, while identifying significant facility-level variation in VHA.
Funding Veterans Health Administration Office of Informatics and Analytics.
Click on the PDF icon at the top of this introduction to read the full article.
Background Morbidity related to cancer and its treatment remains a significant source of human suffering and a challenge to the delivery of high-quality care.
Objective To develop and apply quality indicators to evaluate quality of supportive care for advanced lung cancer in the Veterans Health Administration (VHA) and examine facility-level predictors of quality.
Methods We evaluated supportive care quality using 12 quality indicators. Data were taken from VHA electronic health records for incident lung cancer cases occurring during 2007. Organizational characteristics of 111 VHA facilities were examined for association with receipt of care.
Results Rates of care-receipt were high, especially in the treatment toxicity (89%) and pain management (79%-98%) domains, but were lower in the palliative cancer treatment (60%-90%) and hospice (75%) domains, with substantial facility- level variation. Presence of a care tracking method that was monitored by a midlevel practitioner seemed to be associated with better quality for treatment toxicity (OR, 3.38; 95% CI, 1.87-6.10) and referral to hospice (OR, 1.60; 95% CI, 1.22-2.28); having a psychologist for cancer patients was associated with higher odds for pain management (OR, 1.76; 95% CI, 1.16-2.66).
Limitations Not all supportive care was evaluated. Care processes identified as present at facilities may not have been applied to cohort patients. Facility-level results may be influenced by errors in attributing a patient’s care to the correct facility.
Conclusions Quality indicators for supportive cancer care can be developed and applied in large evaluations using electronic health record review. This study confirmed high-quality supportive care, while identifying significant facility-level variation in VHA.
Funding Veterans Health Administration Office of Informatics and Analytics.
Click on the PDF icon at the top of this introduction to read the full article.
Background Morbidity related to cancer and its treatment remains a significant source of human suffering and a challenge to the delivery of high-quality care.
Objective To develop and apply quality indicators to evaluate quality of supportive care for advanced lung cancer in the Veterans Health Administration (VHA) and examine facility-level predictors of quality.
Methods We evaluated supportive care quality using 12 quality indicators. Data were taken from VHA electronic health records for incident lung cancer cases occurring during 2007. Organizational characteristics of 111 VHA facilities were examined for association with receipt of care.
Results Rates of care-receipt were high, especially in the treatment toxicity (89%) and pain management (79%-98%) domains, but were lower in the palliative cancer treatment (60%-90%) and hospice (75%) domains, with substantial facility- level variation. Presence of a care tracking method that was monitored by a midlevel practitioner seemed to be associated with better quality for treatment toxicity (OR, 3.38; 95% CI, 1.87-6.10) and referral to hospice (OR, 1.60; 95% CI, 1.22-2.28); having a psychologist for cancer patients was associated with higher odds for pain management (OR, 1.76; 95% CI, 1.16-2.66).
Limitations Not all supportive care was evaluated. Care processes identified as present at facilities may not have been applied to cohort patients. Facility-level results may be influenced by errors in attributing a patient’s care to the correct facility.
Conclusions Quality indicators for supportive cancer care can be developed and applied in large evaluations using electronic health record review. This study confirmed high-quality supportive care, while identifying significant facility-level variation in VHA.
Funding Veterans Health Administration Office of Informatics and Analytics.
Click on the PDF icon at the top of this introduction to read the full article.
Weight change associated with third-generation adjuvant chemotherapy in breast cancer patients
Methods We retrospectively analyzed the mean percentage weight change during the first year after breast cancer diagnosis in 246 patients at West Virginia University during September 2007 and October 2010. Kruskal-Wallis test and post hoc pairwise comparisons were used to assess the influence of age, histology, stage, ER/PR/HER2/neu status, menopausal status, and types of therapeutic modalities received on the percentage weight change. Kaplan-Meier method with log-rank test was used to evaluate recurrence-free survival (RFS). Local or distant recurrence and disease progression were events for RFS analysis and disease-free patients were censored at last follow-up.
Results Mean weight gain was 0.39% (SD, 0.40) of baseline body weight, 1 year after diagnosis of breast cancer. Premenopausal status was the only factor associated with significant weight gain (+1.67% vs -0.10% for postmenopausal patients; P = .02). Stages ≥ III was associated with significant weight loss (-1.64% for stages III, IV vs +0.85% for stages 0, I, II; P = .02) and a lower RFS at 3 years and 5 years (P < .0001). Higher baseline weight (> 90th percentile) did not have any significant impact on RFS (0.84 vs 0.91; P = .19). There was no significant change in weight relative to other factors.
Conclusion Our study in patients receiving third-generation adjuvant chemotherapy regimens did not show any significant change in percentage weight with chemotherapy. Premenopausal status was the only significant factor associated with weight gain. As expected, stage III or higher disease was associated with significant weight loss and lower RFS.
Click on the PDF icon at the top of this introduction to read the full article.
Methods We retrospectively analyzed the mean percentage weight change during the first year after breast cancer diagnosis in 246 patients at West Virginia University during September 2007 and October 2010. Kruskal-Wallis test and post hoc pairwise comparisons were used to assess the influence of age, histology, stage, ER/PR/HER2/neu status, menopausal status, and types of therapeutic modalities received on the percentage weight change. Kaplan-Meier method with log-rank test was used to evaluate recurrence-free survival (RFS). Local or distant recurrence and disease progression were events for RFS analysis and disease-free patients were censored at last follow-up.
Results Mean weight gain was 0.39% (SD, 0.40) of baseline body weight, 1 year after diagnosis of breast cancer. Premenopausal status was the only factor associated with significant weight gain (+1.67% vs -0.10% for postmenopausal patients; P = .02). Stages ≥ III was associated with significant weight loss (-1.64% for stages III, IV vs +0.85% for stages 0, I, II; P = .02) and a lower RFS at 3 years and 5 years (P < .0001). Higher baseline weight (> 90th percentile) did not have any significant impact on RFS (0.84 vs 0.91; P = .19). There was no significant change in weight relative to other factors.
Conclusion Our study in patients receiving third-generation adjuvant chemotherapy regimens did not show any significant change in percentage weight with chemotherapy. Premenopausal status was the only significant factor associated with weight gain. As expected, stage III or higher disease was associated with significant weight loss and lower RFS.
Click on the PDF icon at the top of this introduction to read the full article.
Methods We retrospectively analyzed the mean percentage weight change during the first year after breast cancer diagnosis in 246 patients at West Virginia University during September 2007 and October 2010. Kruskal-Wallis test and post hoc pairwise comparisons were used to assess the influence of age, histology, stage, ER/PR/HER2/neu status, menopausal status, and types of therapeutic modalities received on the percentage weight change. Kaplan-Meier method with log-rank test was used to evaluate recurrence-free survival (RFS). Local or distant recurrence and disease progression were events for RFS analysis and disease-free patients were censored at last follow-up.
Results Mean weight gain was 0.39% (SD, 0.40) of baseline body weight, 1 year after diagnosis of breast cancer. Premenopausal status was the only factor associated with significant weight gain (+1.67% vs -0.10% for postmenopausal patients; P = .02). Stages ≥ III was associated with significant weight loss (-1.64% for stages III, IV vs +0.85% for stages 0, I, II; P = .02) and a lower RFS at 3 years and 5 years (P < .0001). Higher baseline weight (> 90th percentile) did not have any significant impact on RFS (0.84 vs 0.91; P = .19). There was no significant change in weight relative to other factors.
Conclusion Our study in patients receiving third-generation adjuvant chemotherapy regimens did not show any significant change in percentage weight with chemotherapy. Premenopausal status was the only significant factor associated with weight gain. As expected, stage III or higher disease was associated with significant weight loss and lower RFS.
Click on the PDF icon at the top of this introduction to read the full article.
Informational needs and the quality of life of patients in their first year after metastatic breast cancer diagnosis
Objective To describe the informational needs and QOL of patients with MBC within the first year of diagnosis, and to identify sociodemographic and medical factors that may be associated with informational needs and QOL.
Methods 52 patients (50 women, 2 men) enrolled within a year of diagnosis of MBC completed a cross-sectional, self-administered paper survey that included patient demographics, the Toronto Informational Needs Questionnaire-Breast Cancer (TINQ), the Hospital Anxiety and Depression Scale (HADS), and Medical Outcomes Study Short Form-36 (SF-36). High informational need was defined as a TINQ score of ≥ 200.
Results Of the total 52 patients, 69% (35/52) had high informational needs, 20% met the criteria for anxiety (HADS-Anxiety score, ≥ 11), and 8% met the criteria for depression. SF-36 scores were lower in all 8 subscales compared with the general population. Multivariate analyses showed that patients who were married or living as married (OR, 6.1; 95% CI, 1.4-28.9) and patients with de novo MBC (OR, 2.8; 95% CI, 0.5-14.3) or a shorter disease-free interval (DFI; < 5 years; OR, 24.2; 95% CI, 3.1-187.4) were more likely to have more informational needs (C statistic, 0.824) than were patients with a longer DFI (≥ 5 years).
Limitations This is a small cross-sectional study of a single academic institution.
Conclusion Patients with recently diagnosed MBC have high informational needs and decreased overall QOL. Additional research and supportive services meeting the informational and psychosocial needs of patients living with MBC are warranted.
Funding Metastatic Research Fund (anonymous donor), the Megan Lally Memorial Fund, the Nancy and Randy Berry Junior Faculty Award, the Karen Webster & David Evans Metastatic Research Fund, and the Susan G Komen for the Cure.
Click on the PDF icon at the top of this introduction to read the full article.
Objective To describe the informational needs and QOL of patients with MBC within the first year of diagnosis, and to identify sociodemographic and medical factors that may be associated with informational needs and QOL.
Methods 52 patients (50 women, 2 men) enrolled within a year of diagnosis of MBC completed a cross-sectional, self-administered paper survey that included patient demographics, the Toronto Informational Needs Questionnaire-Breast Cancer (TINQ), the Hospital Anxiety and Depression Scale (HADS), and Medical Outcomes Study Short Form-36 (SF-36). High informational need was defined as a TINQ score of ≥ 200.
Results Of the total 52 patients, 69% (35/52) had high informational needs, 20% met the criteria for anxiety (HADS-Anxiety score, ≥ 11), and 8% met the criteria for depression. SF-36 scores were lower in all 8 subscales compared with the general population. Multivariate analyses showed that patients who were married or living as married (OR, 6.1; 95% CI, 1.4-28.9) and patients with de novo MBC (OR, 2.8; 95% CI, 0.5-14.3) or a shorter disease-free interval (DFI; < 5 years; OR, 24.2; 95% CI, 3.1-187.4) were more likely to have more informational needs (C statistic, 0.824) than were patients with a longer DFI (≥ 5 years).
Limitations This is a small cross-sectional study of a single academic institution.
Conclusion Patients with recently diagnosed MBC have high informational needs and decreased overall QOL. Additional research and supportive services meeting the informational and psychosocial needs of patients living with MBC are warranted.
Funding Metastatic Research Fund (anonymous donor), the Megan Lally Memorial Fund, the Nancy and Randy Berry Junior Faculty Award, the Karen Webster & David Evans Metastatic Research Fund, and the Susan G Komen for the Cure.
Click on the PDF icon at the top of this introduction to read the full article.
Objective To describe the informational needs and QOL of patients with MBC within the first year of diagnosis, and to identify sociodemographic and medical factors that may be associated with informational needs and QOL.
Methods 52 patients (50 women, 2 men) enrolled within a year of diagnosis of MBC completed a cross-sectional, self-administered paper survey that included patient demographics, the Toronto Informational Needs Questionnaire-Breast Cancer (TINQ), the Hospital Anxiety and Depression Scale (HADS), and Medical Outcomes Study Short Form-36 (SF-36). High informational need was defined as a TINQ score of ≥ 200.
Results Of the total 52 patients, 69% (35/52) had high informational needs, 20% met the criteria for anxiety (HADS-Anxiety score, ≥ 11), and 8% met the criteria for depression. SF-36 scores were lower in all 8 subscales compared with the general population. Multivariate analyses showed that patients who were married or living as married (OR, 6.1; 95% CI, 1.4-28.9) and patients with de novo MBC (OR, 2.8; 95% CI, 0.5-14.3) or a shorter disease-free interval (DFI; < 5 years; OR, 24.2; 95% CI, 3.1-187.4) were more likely to have more informational needs (C statistic, 0.824) than were patients with a longer DFI (≥ 5 years).
Limitations This is a small cross-sectional study of a single academic institution.
Conclusion Patients with recently diagnosed MBC have high informational needs and decreased overall QOL. Additional research and supportive services meeting the informational and psychosocial needs of patients living with MBC are warranted.
Funding Metastatic Research Fund (anonymous donor), the Megan Lally Memorial Fund, the Nancy and Randy Berry Junior Faculty Award, the Karen Webster & David Evans Metastatic Research Fund, and the Susan G Komen for the Cure.
Click on the PDF icon at the top of this introduction to read the full article.
Practice gaps and barriers to optimal care of hematologic malignancies in the United States
Objective To identify clinical challenges among hematologists and medical oncologists regarding the provision of care to patients with chronic myeloid leukemia (CML), acute lymphoblastic leukemia (ALL), or B-cell lymphomas.
Methods Hematologists and medical oncologists in active practice in the United States and who have a case load of ≥ 1 patient a year with CML, ALL, or B-cell lymphoma were recruited. The initial qualitative phase consisted of an online case-based survey followed by an interview exploring the contextual and behavioral factors that influence treatment decisions (n = 27). The analysis of qualitative data then informed a quantitative phase, in which 121 participants completed an online survey composed of case vignettes, multiple choice, and semantic differential rating scale questions. The respondents’ answers were compared with recommendations from treatment guidelines and faculty experts.
Results A higher frequency of bone marrow biopsies was reported compared with expert faculty recommendations by 74% of oncologists. Many respondents failed to recognize the clinical relevance of BCR-ABL mutations other than T315I. Respondents reported perceiving difficulties in individualizing treatment and interpreting response to treatment in patients with ALL and B-cell lymphomas. Fewer than 30% of respondents recognized the mechanisms of action of 5 of the 9 promising investigational agents presented.
Limitations Participant self-selection bias is a possibility because participation was voluntary. Practice gaps are not based on clinical data, but hypothetical case situations and self-report.
Conclusions Findings from this study can guide education to address the identified challenges in caring for patients with hematologic malignancies and improving patient care.
Funding This needs assessment was financially supported with an educational research grant from Pfizer Medical Education Group to the Annenberg Center for Health Sciences at Eisenhower.
Click on the PDF icon at the top of this introduction to read the full article.
Objective To identify clinical challenges among hematologists and medical oncologists regarding the provision of care to patients with chronic myeloid leukemia (CML), acute lymphoblastic leukemia (ALL), or B-cell lymphomas.
Methods Hematologists and medical oncologists in active practice in the United States and who have a case load of ≥ 1 patient a year with CML, ALL, or B-cell lymphoma were recruited. The initial qualitative phase consisted of an online case-based survey followed by an interview exploring the contextual and behavioral factors that influence treatment decisions (n = 27). The analysis of qualitative data then informed a quantitative phase, in which 121 participants completed an online survey composed of case vignettes, multiple choice, and semantic differential rating scale questions. The respondents’ answers were compared with recommendations from treatment guidelines and faculty experts.
Results A higher frequency of bone marrow biopsies was reported compared with expert faculty recommendations by 74% of oncologists. Many respondents failed to recognize the clinical relevance of BCR-ABL mutations other than T315I. Respondents reported perceiving difficulties in individualizing treatment and interpreting response to treatment in patients with ALL and B-cell lymphomas. Fewer than 30% of respondents recognized the mechanisms of action of 5 of the 9 promising investigational agents presented.
Limitations Participant self-selection bias is a possibility because participation was voluntary. Practice gaps are not based on clinical data, but hypothetical case situations and self-report.
Conclusions Findings from this study can guide education to address the identified challenges in caring for patients with hematologic malignancies and improving patient care.
Funding This needs assessment was financially supported with an educational research grant from Pfizer Medical Education Group to the Annenberg Center for Health Sciences at Eisenhower.
Click on the PDF icon at the top of this introduction to read the full article.
Objective To identify clinical challenges among hematologists and medical oncologists regarding the provision of care to patients with chronic myeloid leukemia (CML), acute lymphoblastic leukemia (ALL), or B-cell lymphomas.
Methods Hematologists and medical oncologists in active practice in the United States and who have a case load of ≥ 1 patient a year with CML, ALL, or B-cell lymphoma were recruited. The initial qualitative phase consisted of an online case-based survey followed by an interview exploring the contextual and behavioral factors that influence treatment decisions (n = 27). The analysis of qualitative data then informed a quantitative phase, in which 121 participants completed an online survey composed of case vignettes, multiple choice, and semantic differential rating scale questions. The respondents’ answers were compared with recommendations from treatment guidelines and faculty experts.
Results A higher frequency of bone marrow biopsies was reported compared with expert faculty recommendations by 74% of oncologists. Many respondents failed to recognize the clinical relevance of BCR-ABL mutations other than T315I. Respondents reported perceiving difficulties in individualizing treatment and interpreting response to treatment in patients with ALL and B-cell lymphomas. Fewer than 30% of respondents recognized the mechanisms of action of 5 of the 9 promising investigational agents presented.
Limitations Participant self-selection bias is a possibility because participation was voluntary. Practice gaps are not based on clinical data, but hypothetical case situations and self-report.
Conclusions Findings from this study can guide education to address the identified challenges in caring for patients with hematologic malignancies and improving patient care.
Funding This needs assessment was financially supported with an educational research grant from Pfizer Medical Education Group to the Annenberg Center for Health Sciences at Eisenhower.
Click on the PDF icon at the top of this introduction to read the full article.
Treatment patterns and clinical effectiveness in metastatic castrate resistant prostate cancer after first-line docetaxel
Objective To examine treatment patterns, sequencing, and outcomes in patients receiving second- and third-line treatment after first-line docetaxel.
Methods We used a community oncology database to identify patients who progressed after line 1 docetaxel (D) and received line 2 cabazitaxel (DC), abiraterone (DA), or other therapy (DO). Progression-free survival (PFS) and overall survival (OS) were assessed using Kaplan- Meier and Cox regression models. Line 3 included subsets DCA and DAC.
Results Line 2 groups (DC = 60 patients, DA = 71, DO = 153) did not differ significantly on demographic and clinical characteristics or median PFS on docetaxel therapy. Cox regression for OS by line 2 groups showed increased risk for DA compared with DC (HR, 1.69; P = .026) when 24 untreated DO patients were excluded. A similar nonsignificant pattern was observed when the 24 untreated patients were included. Of patients receiving DC in line 2, a nominally greater proportion received A in line 3 (57%, 34 of 60 patients) than did patients who received DA in line 2 followed by C in line 3 (25%, 18 of 71).
Limitations There was a small sample for line 3, and unexamined confounds and selection biases in observational research. Conclusions Treatment patterns in community settings following docetaxel are complex and may involve multiple hormonal agents prior to disease progression. Cabazitaxel may not be optimally used in advanced disease. Although Cox regression showed increased risk of death for DA compared with DC, results need to be validated prospectively.
Funding and disclosures This study was funded by Sanof US LLC. Dr Hennessy and Mr Thompson are employed by Sanof. Dr Hennessy holds restricted stock units and company stock in Sanof. Dr Nicacio was previously employed by Sanof. Drs Houts, Walker, and Miller’s institution is receiving research funding from Sanof for other research projects. Dr Walker’s institution received honoraria and travel expenses for his previous advisory board participation. Dr Somer declares no conflicts.
Click on the PDF icon at the top of this introduction to read the full article.
Objective To examine treatment patterns, sequencing, and outcomes in patients receiving second- and third-line treatment after first-line docetaxel.
Methods We used a community oncology database to identify patients who progressed after line 1 docetaxel (D) and received line 2 cabazitaxel (DC), abiraterone (DA), or other therapy (DO). Progression-free survival (PFS) and overall survival (OS) were assessed using Kaplan- Meier and Cox regression models. Line 3 included subsets DCA and DAC.
Results Line 2 groups (DC = 60 patients, DA = 71, DO = 153) did not differ significantly on demographic and clinical characteristics or median PFS on docetaxel therapy. Cox regression for OS by line 2 groups showed increased risk for DA compared with DC (HR, 1.69; P = .026) when 24 untreated DO patients were excluded. A similar nonsignificant pattern was observed when the 24 untreated patients were included. Of patients receiving DC in line 2, a nominally greater proportion received A in line 3 (57%, 34 of 60 patients) than did patients who received DA in line 2 followed by C in line 3 (25%, 18 of 71).
Limitations There was a small sample for line 3, and unexamined confounds and selection biases in observational research. Conclusions Treatment patterns in community settings following docetaxel are complex and may involve multiple hormonal agents prior to disease progression. Cabazitaxel may not be optimally used in advanced disease. Although Cox regression showed increased risk of death for DA compared with DC, results need to be validated prospectively.
Funding and disclosures This study was funded by Sanof US LLC. Dr Hennessy and Mr Thompson are employed by Sanof. Dr Hennessy holds restricted stock units and company stock in Sanof. Dr Nicacio was previously employed by Sanof. Drs Houts, Walker, and Miller’s institution is receiving research funding from Sanof for other research projects. Dr Walker’s institution received honoraria and travel expenses for his previous advisory board participation. Dr Somer declares no conflicts.
Click on the PDF icon at the top of this introduction to read the full article.
Objective To examine treatment patterns, sequencing, and outcomes in patients receiving second- and third-line treatment after first-line docetaxel.
Methods We used a community oncology database to identify patients who progressed after line 1 docetaxel (D) and received line 2 cabazitaxel (DC), abiraterone (DA), or other therapy (DO). Progression-free survival (PFS) and overall survival (OS) were assessed using Kaplan- Meier and Cox regression models. Line 3 included subsets DCA and DAC.
Results Line 2 groups (DC = 60 patients, DA = 71, DO = 153) did not differ significantly on demographic and clinical characteristics or median PFS on docetaxel therapy. Cox regression for OS by line 2 groups showed increased risk for DA compared with DC (HR, 1.69; P = .026) when 24 untreated DO patients were excluded. A similar nonsignificant pattern was observed when the 24 untreated patients were included. Of patients receiving DC in line 2, a nominally greater proportion received A in line 3 (57%, 34 of 60 patients) than did patients who received DA in line 2 followed by C in line 3 (25%, 18 of 71).
Limitations There was a small sample for line 3, and unexamined confounds and selection biases in observational research. Conclusions Treatment patterns in community settings following docetaxel are complex and may involve multiple hormonal agents prior to disease progression. Cabazitaxel may not be optimally used in advanced disease. Although Cox regression showed increased risk of death for DA compared with DC, results need to be validated prospectively.
Funding and disclosures This study was funded by Sanof US LLC. Dr Hennessy and Mr Thompson are employed by Sanof. Dr Hennessy holds restricted stock units and company stock in Sanof. Dr Nicacio was previously employed by Sanof. Drs Houts, Walker, and Miller’s institution is receiving research funding from Sanof for other research projects. Dr Walker’s institution received honoraria and travel expenses for his previous advisory board participation. Dr Somer declares no conflicts.
Click on the PDF icon at the top of this introduction to read the full article.
Bacteremia in adult cancer patients with apparently stable febrile neutropenia: data from a cohort of 692 consecutive episodes from a single institution
Background Bacteremia is associated with increased risk of complications in patients with febrile neutropenia (FN), although few clinical studies have reported outcomes in apparently stable patients (ASPs) who could be candidates for home treatment.
Objective To assess the risk factors and the impact of bacteremia in ASPs.
Methods We retrospectively analyzed 861 consecutive episodes of FN that were classified according to their presentation into 2 categories: clearly unstable patients and ASPs. We estimated the incidence of bacteremia and severe complications in ASPs. We analyzed predictors for bacteremia and the discriminatory ability of the MASCC score in this setting.
Results We classified 692 episodes as ASPs. Bacteremia occurred in 6%, major complications were noted in 7.3%, and death occurred in 1.3%. Patients with bacteremia had more complications (odds ratio [OR], 8.2), and mortality (OR, 8.2). The integration of the MASCC score and bacteremic status predicted complications with an area under the receiver operating characteristic (ROC) curve of 0.74, sensitivity of 36%, and specificity of 94%. Predictors of bacteremia were temperature ≥ 39°C/102.2°F (OR, 3), rigors (OR, 2.2), ECOG PS ≥ 2 (OR, 2.1), and advanced cancer (OR, 2.5). Two percent of patients who remained afebrile for 48 hours had positive blood cultures afterward.
Limitations A single-center, retrospective analysis, and the absence of a validation set to test the model’s discriminatory ability.
Conclusions Bacteremia is infrequent among ASPs but is associated with a high risk of complications. We identified several variables that could improve the prognostic classification of clinically stable FN.
Click on the PDF icon at the top of this introduction to read the full article.
Background Bacteremia is associated with increased risk of complications in patients with febrile neutropenia (FN), although few clinical studies have reported outcomes in apparently stable patients (ASPs) who could be candidates for home treatment.
Objective To assess the risk factors and the impact of bacteremia in ASPs.
Methods We retrospectively analyzed 861 consecutive episodes of FN that were classified according to their presentation into 2 categories: clearly unstable patients and ASPs. We estimated the incidence of bacteremia and severe complications in ASPs. We analyzed predictors for bacteremia and the discriminatory ability of the MASCC score in this setting.
Results We classified 692 episodes as ASPs. Bacteremia occurred in 6%, major complications were noted in 7.3%, and death occurred in 1.3%. Patients with bacteremia had more complications (odds ratio [OR], 8.2), and mortality (OR, 8.2). The integration of the MASCC score and bacteremic status predicted complications with an area under the receiver operating characteristic (ROC) curve of 0.74, sensitivity of 36%, and specificity of 94%. Predictors of bacteremia were temperature ≥ 39°C/102.2°F (OR, 3), rigors (OR, 2.2), ECOG PS ≥ 2 (OR, 2.1), and advanced cancer (OR, 2.5). Two percent of patients who remained afebrile for 48 hours had positive blood cultures afterward.
Limitations A single-center, retrospective analysis, and the absence of a validation set to test the model’s discriminatory ability.
Conclusions Bacteremia is infrequent among ASPs but is associated with a high risk of complications. We identified several variables that could improve the prognostic classification of clinically stable FN.
Click on the PDF icon at the top of this introduction to read the full article.
Background Bacteremia is associated with increased risk of complications in patients with febrile neutropenia (FN), although few clinical studies have reported outcomes in apparently stable patients (ASPs) who could be candidates for home treatment.
Objective To assess the risk factors and the impact of bacteremia in ASPs.
Methods We retrospectively analyzed 861 consecutive episodes of FN that were classified according to their presentation into 2 categories: clearly unstable patients and ASPs. We estimated the incidence of bacteremia and severe complications in ASPs. We analyzed predictors for bacteremia and the discriminatory ability of the MASCC score in this setting.
Results We classified 692 episodes as ASPs. Bacteremia occurred in 6%, major complications were noted in 7.3%, and death occurred in 1.3%. Patients with bacteremia had more complications (odds ratio [OR], 8.2), and mortality (OR, 8.2). The integration of the MASCC score and bacteremic status predicted complications with an area under the receiver operating characteristic (ROC) curve of 0.74, sensitivity of 36%, and specificity of 94%. Predictors of bacteremia were temperature ≥ 39°C/102.2°F (OR, 3), rigors (OR, 2.2), ECOG PS ≥ 2 (OR, 2.1), and advanced cancer (OR, 2.5). Two percent of patients who remained afebrile for 48 hours had positive blood cultures afterward.
Limitations A single-center, retrospective analysis, and the absence of a validation set to test the model’s discriminatory ability.
Conclusions Bacteremia is infrequent among ASPs but is associated with a high risk of complications. We identified several variables that could improve the prognostic classification of clinically stable FN.
Click on the PDF icon at the top of this introduction to read the full article.
Breast cancer in male veteran population: an analysis from VA cancer registry
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.
Effects of exercise on disablement process model outcomes in prostate cancer patients undergoing androgen deprivation therapy
Objective To explore whether exercise results in comparable improvements in physiologic and structural body system impairment, functional limitation (relating to basic physical or mental actions), and physical disability domain outcomes identified in the Disablement Process Model (DPM) in PC patients who are receiving ADT.
Methods Data from studies of exercise interventions in men on ADT were extracted on impairment, functional limitation, and physical disability domain outcomes. The average of weighted, bias-corrected effect sizes were calculated for each outcome and compared across domains. A total of 9 studies (6 randomized controlled trials, 3 uncontrolled trials) conducted with 684 PC patients met the inclusion criteria.
Results Exercise yielded heterogeneous effect-size improvements in physical impairments, ranging from large improvements in muscular strength (d = .74; 95% CI, .14-1.47) and endurance (d = 2.64; 95% CI, 1.08-2.84), to small improvements in body composition measures (d = .12; 95% CI, -.52-.68).
Conclusions Whereas exercise resulted in meaningful effect-size improvements in functional limitation domain outcomes (d = .39; 95% CI, -.42-1.01), findings from the 4 studies that assessed a physical disability, domain outcomes revealed only small improvements (d = .10; 95% CI, -.44-.43) in these outcomes. Collectively, exercise consistently results in meaningful improvements in physical impairments and functional limitations in basic physical tasks. However, to date, few studies have evaluated the effects of exercise on physical disability domain outcomes, and the results suggest that the effects of exercise on physical disability measures are of a smaller magnitude relative to those observed for impairment and functional limitation domain outcomes.
Click on the PDF icon at the top of this introduction to read the full article.
Objective To explore whether exercise results in comparable improvements in physiologic and structural body system impairment, functional limitation (relating to basic physical or mental actions), and physical disability domain outcomes identified in the Disablement Process Model (DPM) in PC patients who are receiving ADT.
Methods Data from studies of exercise interventions in men on ADT were extracted on impairment, functional limitation, and physical disability domain outcomes. The average of weighted, bias-corrected effect sizes were calculated for each outcome and compared across domains. A total of 9 studies (6 randomized controlled trials, 3 uncontrolled trials) conducted with 684 PC patients met the inclusion criteria.
Results Exercise yielded heterogeneous effect-size improvements in physical impairments, ranging from large improvements in muscular strength (d = .74; 95% CI, .14-1.47) and endurance (d = 2.64; 95% CI, 1.08-2.84), to small improvements in body composition measures (d = .12; 95% CI, -.52-.68).
Conclusions Whereas exercise resulted in meaningful effect-size improvements in functional limitation domain outcomes (d = .39; 95% CI, -.42-1.01), findings from the 4 studies that assessed a physical disability, domain outcomes revealed only small improvements (d = .10; 95% CI, -.44-.43) in these outcomes. Collectively, exercise consistently results in meaningful improvements in physical impairments and functional limitations in basic physical tasks. However, to date, few studies have evaluated the effects of exercise on physical disability domain outcomes, and the results suggest that the effects of exercise on physical disability measures are of a smaller magnitude relative to those observed for impairment and functional limitation domain outcomes.
Click on the PDF icon at the top of this introduction to read the full article.
Objective To explore whether exercise results in comparable improvements in physiologic and structural body system impairment, functional limitation (relating to basic physical or mental actions), and physical disability domain outcomes identified in the Disablement Process Model (DPM) in PC patients who are receiving ADT.
Methods Data from studies of exercise interventions in men on ADT were extracted on impairment, functional limitation, and physical disability domain outcomes. The average of weighted, bias-corrected effect sizes were calculated for each outcome and compared across domains. A total of 9 studies (6 randomized controlled trials, 3 uncontrolled trials) conducted with 684 PC patients met the inclusion criteria.
Results Exercise yielded heterogeneous effect-size improvements in physical impairments, ranging from large improvements in muscular strength (d = .74; 95% CI, .14-1.47) and endurance (d = 2.64; 95% CI, 1.08-2.84), to small improvements in body composition measures (d = .12; 95% CI, -.52-.68).
Conclusions Whereas exercise resulted in meaningful effect-size improvements in functional limitation domain outcomes (d = .39; 95% CI, -.42-1.01), findings from the 4 studies that assessed a physical disability, domain outcomes revealed only small improvements (d = .10; 95% CI, -.44-.43) in these outcomes. Collectively, exercise consistently results in meaningful improvements in physical impairments and functional limitations in basic physical tasks. However, to date, few studies have evaluated the effects of exercise on physical disability domain outcomes, and the results suggest that the effects of exercise on physical disability measures are of a smaller magnitude relative to those observed for impairment and functional limitation domain outcomes.
Click on the PDF icon at the top of this introduction to read the full article.