Avoiding Harmful Palliative Chemotherapy Treatment in the End of Life: Development of a Brief Patient-Completed Questionnaire for Routine Assessment of Performance Status

Ulla Näppä, RN, MSc

Avoiding Harmful Palliative Chemotherapy Treatment in the End of Life: Development of a Brief Patient-Completed Questionnaire for Routine Assessment of Performance Status

Ulla Näppä, RN, MSc

Avoiding Harmful Palliative Chemotherapy Treatment in the End of Life: Development of a Brief Patient-Completed Questionnaire for Routine Assessment of Performance Status

Ulla Näppä, RN, MSc

Donna Van Bogaert, PhD

Donna Van Bogaert, PhD

Donna Van Bogaert, PhD

Fiona Naumann, PhD

*For a PDF of the full article, click on the link to the left of this introduction.

Fiona Naumann, PhD

*For a PDF of the full article, click on the link to the left of this introduction.

Fiona Naumann, PhD

*For a PDF of the full article, click on the link to the left of this introduction.

Background: The Hispanic population accounts for 15% of the population of the United States, and for as much as 75% in cities throughout California. Racial disparities that are reflected by limited access to health care and worse disease outcomes are well documented for adult Hispanic cancer patients.

Objective: To determine whether there are similar disparities—including delays in accessing surgery, radiation, and oncologic care—for adult Hispanic non English-speaking (HNES) neuro-oncology patients and white English-only–speaking (WES) patients in an academic, tertiary care center with a multidisciplinary neuro-oncology team.

Methods: This retrospective study was conducted at the Chao Family Comprehensive Cancer Center of the University of California, Irvine. All patients who were diagnosed with a primary brain tumor during January 1, 2003, to December 31, 2008, were identified and data were collected on their age, sex, ethnicity, languages spoken, diagnosis, and insurance status. The times from the date of diagnosis to the date of surgery, from the date of surgery to the date of starting radiation (if indicated), and from the date of finishing radiation to the date of starting chemotherapy (if indicated) were also recorded.

Results: Most of the HNES patients (56.4%) had state insurance for the indigent, whereas most of the WES patients (41.8%) had private insurance from a health maintenance organization. Moreover, 12.8% of HNES patients were uninsured, compared with 4.5% of WES patients. There were no significant delays in the time from diagnosis to surgery, but there was a significant delay in access to radiation treatment (P   .023). There were no differences on overall survival between the 2 groups of patients.

Limitations: This is a retrospective study of a relatively small number of patients. Larger studies are needed to corroborate these findings

Conclusions: The findings demonstrate that there are disparities in insurance status and access to radiation therapy between HNES and WES neuro-oncology patients.

*To read the the full article, click on the link at the top of this introduction.

Background: The Hispanic population accounts for 15% of the population of the United States, and for as much as 75% in cities throughout California. Racial disparities that are reflected by limited access to health care and worse disease outcomes are well documented for adult Hispanic cancer patients.

Objective: To determine whether there are similar disparities—including delays in accessing surgery, radiation, and oncologic care—for adult Hispanic non English-speaking (HNES) neuro-oncology patients and white English-only–speaking (WES) patients in an academic, tertiary care center with a multidisciplinary neuro-oncology team.

Methods: This retrospective study was conducted at the Chao Family Comprehensive Cancer Center of the University of California, Irvine. All patients who were diagnosed with a primary brain tumor during January 1, 2003, to December 31, 2008, were identified and data were collected on their age, sex, ethnicity, languages spoken, diagnosis, and insurance status. The times from the date of diagnosis to the date of surgery, from the date of surgery to the date of starting radiation (if indicated), and from the date of finishing radiation to the date of starting chemotherapy (if indicated) were also recorded.

Results: Most of the HNES patients (56.4%) had state insurance for the indigent, whereas most of the WES patients (41.8%) had private insurance from a health maintenance organization. Moreover, 12.8% of HNES patients were uninsured, compared with 4.5% of WES patients. There were no significant delays in the time from diagnosis to surgery, but there was a significant delay in access to radiation treatment (P   .023). There were no differences on overall survival between the 2 groups of patients.

Limitations: This is a retrospective study of a relatively small number of patients. Larger studies are needed to corroborate these findings

Conclusions: The findings demonstrate that there are disparities in insurance status and access to radiation therapy between HNES and WES neuro-oncology patients.

*To read the the full article, click on the link at the top of this introduction.

Background: The Hispanic population accounts for 15% of the population of the United States, and for as much as 75% in cities throughout California. Racial disparities that are reflected by limited access to health care and worse disease outcomes are well documented for adult Hispanic cancer patients.

Objective: To determine whether there are similar disparities—including delays in accessing surgery, radiation, and oncologic care—for adult Hispanic non English-speaking (HNES) neuro-oncology patients and white English-only–speaking (WES) patients in an academic, tertiary care center with a multidisciplinary neuro-oncology team.

Methods: This retrospective study was conducted at the Chao Family Comprehensive Cancer Center of the University of California, Irvine. All patients who were diagnosed with a primary brain tumor during January 1, 2003, to December 31, 2008, were identified and data were collected on their age, sex, ethnicity, languages spoken, diagnosis, and insurance status. The times from the date of diagnosis to the date of surgery, from the date of surgery to the date of starting radiation (if indicated), and from the date of finishing radiation to the date of starting chemotherapy (if indicated) were also recorded.

Results: Most of the HNES patients (56.4%) had state insurance for the indigent, whereas most of the WES patients (41.8%) had private insurance from a health maintenance organization. Moreover, 12.8% of HNES patients were uninsured, compared with 4.5% of WES patients. There were no significant delays in the time from diagnosis to surgery, but there was a significant delay in access to radiation treatment (P   .023). There were no differences on overall survival between the 2 groups of patients.

Limitations: This is a retrospective study of a relatively small number of patients. Larger studies are needed to corroborate these findings

Conclusions: The findings demonstrate that there are disparities in insurance status and access to radiation therapy between HNES and WES neuro-oncology patients.

*To read the the full article, click on the link at the top of this introduction.

Background: A direct correlation between the preoperative prostate cancer antigen 3 (PCA3) gene and total tumor volume in postprostatectomy specimens has recently been reported. This suggests that the PCA3 score could serve as a surrogate for tumor burden in patients with prostate cancer. Accordingly, the PCA3 density (that is, the ratio of the PCA3 score to prostate volume) is representative of the degree of prostate volume occupied by tumor.

Objective: To show that the PCA3 density would be directly related to the likelihood of finding cancer on prostate biopsy, given that larger tumors in smaller glands would be more likely to be detected through prostate biopsy.

Methods: We identified 288 men referred for prostate biopsy for an elevated prostate-specific antigen (PSA) level, high PSA velocity, low free- to total-PSA ratio, or suspicious digital rectal exam. All of the patients had had a urinary PCA3 test performed no more than 4 weeks before biopsy, and prostate volume was recorded by transrectal ultrasound determination at the time of biopsy. The diagnostic yield of PSA level, PSA density (PSAD), PCA3 score, and PCA3 density in detecting cancer was evaluated using a receiver operating characteristic (ROC) curve.

Results: Of the 288 patients included for analysis, 183 (63.5%) underwent an initial prostate biopsy and 105 (36.5%) had at least 1 previous negative biopsy. Cancer was detected in 74 (25.7%) patients. The area under the curve was 0.486 for PSA level, 0.590 for PSAD, 0.687 for PCA3 score, and 0.717 for PCA3 density.

Conclusion: PCA3 density is strongly correlated with cancer detection and may be useful in selecting patients for biopsy.

*For a PDF of the full article, click on the link to the left of this introduction.

Background: A direct correlation between the preoperative prostate cancer antigen 3 (PCA3) gene and total tumor volume in postprostatectomy specimens has recently been reported. This suggests that the PCA3 score could serve as a surrogate for tumor burden in patients with prostate cancer. Accordingly, the PCA3 density (that is, the ratio of the PCA3 score to prostate volume) is representative of the degree of prostate volume occupied by tumor.

Objective: To show that the PCA3 density would be directly related to the likelihood of finding cancer on prostate biopsy, given that larger tumors in smaller glands would be more likely to be detected through prostate biopsy.

Methods: We identified 288 men referred for prostate biopsy for an elevated prostate-specific antigen (PSA) level, high PSA velocity, low free- to total-PSA ratio, or suspicious digital rectal exam. All of the patients had had a urinary PCA3 test performed no more than 4 weeks before biopsy, and prostate volume was recorded by transrectal ultrasound determination at the time of biopsy. The diagnostic yield of PSA level, PSA density (PSAD), PCA3 score, and PCA3 density in detecting cancer was evaluated using a receiver operating characteristic (ROC) curve.

Results: Of the 288 patients included for analysis, 183 (63.5%) underwent an initial prostate biopsy and 105 (36.5%) had at least 1 previous negative biopsy. Cancer was detected in 74 (25.7%) patients. The area under the curve was 0.486 for PSA level, 0.590 for PSAD, 0.687 for PCA3 score, and 0.717 for PCA3 density.

Conclusion: PCA3 density is strongly correlated with cancer detection and may be useful in selecting patients for biopsy.

*For a PDF of the full article, click on the link to the left of this introduction.

Background: A direct correlation between the preoperative prostate cancer antigen 3 (PCA3) gene and total tumor volume in postprostatectomy specimens has recently been reported. This suggests that the PCA3 score could serve as a surrogate for tumor burden in patients with prostate cancer. Accordingly, the PCA3 density (that is, the ratio of the PCA3 score to prostate volume) is representative of the degree of prostate volume occupied by tumor.

Objective: To show that the PCA3 density would be directly related to the likelihood of finding cancer on prostate biopsy, given that larger tumors in smaller glands would be more likely to be detected through prostate biopsy.

Methods: We identified 288 men referred for prostate biopsy for an elevated prostate-specific antigen (PSA) level, high PSA velocity, low free- to total-PSA ratio, or suspicious digital rectal exam. All of the patients had had a urinary PCA3 test performed no more than 4 weeks before biopsy, and prostate volume was recorded by transrectal ultrasound determination at the time of biopsy. The diagnostic yield of PSA level, PSA density (PSAD), PCA3 score, and PCA3 density in detecting cancer was evaluated using a receiver operating characteristic (ROC) curve.

Results: Of the 288 patients included for analysis, 183 (63.5%) underwent an initial prostate biopsy and 105 (36.5%) had at least 1 previous negative biopsy. Cancer was detected in 74 (25.7%) patients. The area under the curve was 0.486 for PSA level, 0.590 for PSAD, 0.687 for PCA3 score, and 0.717 for PCA3 density.

Conclusion: PCA3 density is strongly correlated with cancer detection and may be useful in selecting patients for biopsy.

*For a PDF of the full article, click on the link to the left of this introduction.

Background  The prevalence of concomitant depression among cancer survivors is not well established, although half of those diagnosed with cancer are reported to experience depression at some stage during the cancer experience.

Objectives  To establish rates of diagnosed depression in a cohort of nonelderly adult cancer survivors by cancer site, to characterize those with diagnosed depression, and to assess the impact of diagnosed depression on patterns of health care utilization and costs.

Methods  Medical and pharmacy claims data on military health care beneficiaries were used to develop a cohort of survivors across all cancer sites. Selected cases were diagnosed with and treated for cancer in fiscal years 2006-2007, and had at least 1 health care claim each subsequent year through fiscal year 2010 to ensure survival of at least 2 years. All cancer sites were included except those for nonmelanoma skin cancer. Fiscal year 2009 was used as the index year for determining annual health care utilization and costs. Bivariate and regression analyses were used.

Results  Across the cohort of 11,014 cancer survivors, 12.6% had a comorbid diagnosis of depression at the time of or after a cancer diagnosis. The highest rates of diagnosed depression occurred in those with cancers of the esophagus, pancreas, ovary, or bronchus, lung, or other respiratory organ; and were associated with female sex, single marital status, and enlisted sponsor rank. Survivors who were diagnosed with depression had significantly higher health care utilization for inpatient and outpatient services, more medication prescriptions, and higher annual costs.

Limitations  Due to the nature of claims data, we were unable to ascertain cancer stage or phase of illness. In this analysis, we did not include the presence of comorbidities, history of preexisting depression, or health system factors, all of which may impact the rate of depression among cancer survivors.

Conclusions  The findings suggest the importance for the Military Health System, as well as other health care systems, to address the mental health needs of cancer survivors and the fiscal efficiencies of cancer care.

*For a PDF of the full article, click on the link to the left of this introduction.

Background  The prevalence of concomitant depression among cancer survivors is not well established, although half of those diagnosed with cancer are reported to experience depression at some stage during the cancer experience.

Objectives  To establish rates of diagnosed depression in a cohort of nonelderly adult cancer survivors by cancer site, to characterize those with diagnosed depression, and to assess the impact of diagnosed depression on patterns of health care utilization and costs.

Methods  Medical and pharmacy claims data on military health care beneficiaries were used to develop a cohort of survivors across all cancer sites. Selected cases were diagnosed with and treated for cancer in fiscal years 2006-2007, and had at least 1 health care claim each subsequent year through fiscal year 2010 to ensure survival of at least 2 years. All cancer sites were included except those for nonmelanoma skin cancer. Fiscal year 2009 was used as the index year for determining annual health care utilization and costs. Bivariate and regression analyses were used.

Results  Across the cohort of 11,014 cancer survivors, 12.6% had a comorbid diagnosis of depression at the time of or after a cancer diagnosis. The highest rates of diagnosed depression occurred in those with cancers of the esophagus, pancreas, ovary, or bronchus, lung, or other respiratory organ; and were associated with female sex, single marital status, and enlisted sponsor rank. Survivors who were diagnosed with depression had significantly higher health care utilization for inpatient and outpatient services, more medication prescriptions, and higher annual costs.

Limitations  Due to the nature of claims data, we were unable to ascertain cancer stage or phase of illness. In this analysis, we did not include the presence of comorbidities, history of preexisting depression, or health system factors, all of which may impact the rate of depression among cancer survivors.

Conclusions  The findings suggest the importance for the Military Health System, as well as other health care systems, to address the mental health needs of cancer survivors and the fiscal efficiencies of cancer care.

*For a PDF of the full article, click on the link to the left of this introduction.

Background  The prevalence of concomitant depression among cancer survivors is not well established, although half of those diagnosed with cancer are reported to experience depression at some stage during the cancer experience.

Objectives  To establish rates of diagnosed depression in a cohort of nonelderly adult cancer survivors by cancer site, to characterize those with diagnosed depression, and to assess the impact of diagnosed depression on patterns of health care utilization and costs.

Methods  Medical and pharmacy claims data on military health care beneficiaries were used to develop a cohort of survivors across all cancer sites. Selected cases were diagnosed with and treated for cancer in fiscal years 2006-2007, and had at least 1 health care claim each subsequent year through fiscal year 2010 to ensure survival of at least 2 years. All cancer sites were included except those for nonmelanoma skin cancer. Fiscal year 2009 was used as the index year for determining annual health care utilization and costs. Bivariate and regression analyses were used.

Results  Across the cohort of 11,014 cancer survivors, 12.6% had a comorbid diagnosis of depression at the time of or after a cancer diagnosis. The highest rates of diagnosed depression occurred in those with cancers of the esophagus, pancreas, ovary, or bronchus, lung, or other respiratory organ; and were associated with female sex, single marital status, and enlisted sponsor rank. Survivors who were diagnosed with depression had significantly higher health care utilization for inpatient and outpatient services, more medication prescriptions, and higher annual costs.

Limitations  Due to the nature of claims data, we were unable to ascertain cancer stage or phase of illness. In this analysis, we did not include the presence of comorbidities, history of preexisting depression, or health system factors, all of which may impact the rate of depression among cancer survivors.

Conclusions  The findings suggest the importance for the Military Health System, as well as other health care systems, to address the mental health needs of cancer survivors and the fiscal efficiencies of cancer care.

*For a PDF of the full article, click on the link to the left of this introduction.

Perceived Levels of Pain Associated with Bone Marrow Aspirates and Biopsies

• Giampaolo Talamo, MD; Jason Liao, PhD; Jamal Joudeh, MD; Nicholas E. Lamparella, DO; Hoang Dinh, PA; Jozef Malysz, MD; W. Christopher Ehmann, MD

  Abstract

  Background

  Little is known about the degree of pain experienced by patients undergoing a bone marrow aspiration and biopsy (BMAB).

  Objective

  To evaluate the effectiveness of several strategies aimed at reducing the pain score.

  Methods

  We conducted a retrospective analysis of 258 consecutive adult patients who underwent BMAB via 6 different approaches, the first 5 of which were performed by one physician. Group A received local anesthesia with 1% lidocaine hydrochloride (5 mL) and a 5-minute wait time before the procedure; group B received local anesthesia with a double dose (10 mL) of lidocaine; group C received 5 mL of local anesthesia with a 10-minute wait; group D received 5 mL of local anesthesia plus a topical spray with ethyl chloride; group E received oral analgesia and anxiolysis 30 minutes before the procedure in addition to the group A dosage of lidocaine; and group F received the same anesthesia as did group A, but the BMAD was performed by a less experienced practitioner.

  Results

  On a 0 to 10 scale, the mean pain level among the 258 patients was 3.2 (standard deviation = 2.6). Rate of complications was low (<1%). Several strategies failed to improve the pain level, including the administration of a double dose of local anesthesia, waiting longer for the anesthesia effect, and the additional use of a topical anesthetic spray or oral analgesia and anxiolysis. Pain levels were not increased when the procedure was done by a less experienced practitioner. Younger age and female gender were associated with higher pain levels.

  Conclusions

  Given that the average level of perceived pain during BMAB is low to moderate (approximately 3 on a 0-10 scale), the routine use of conscious sedation for this procedure may not be indicated. Several strategies aimed at reducing the pain level, including doubling the dose of anesthesia and using an oral prophylactic regimen of analgesia and anxiolysis, failed to improve pain scores.

  *For a PDF of the full article click in the link to the left of this introduction.

Perceived Levels of Pain Associated with Bone Marrow Aspirates and Biopsies

• Giampaolo Talamo, MD; Jason Liao, PhD; Jamal Joudeh, MD; Nicholas E. Lamparella, DO; Hoang Dinh, PA; Jozef Malysz, MD; W. Christopher Ehmann, MD

  Abstract

  Background

  Little is known about the degree of pain experienced by patients undergoing a bone marrow aspiration and biopsy (BMAB).

  Objective

  To evaluate the effectiveness of several strategies aimed at reducing the pain score.

  Methods

  We conducted a retrospective analysis of 258 consecutive adult patients who underwent BMAB via 6 different approaches, the first 5 of which were performed by one physician. Group A received local anesthesia with 1% lidocaine hydrochloride (5 mL) and a 5-minute wait time before the procedure; group B received local anesthesia with a double dose (10 mL) of lidocaine; group C received 5 mL of local anesthesia with a 10-minute wait; group D received 5 mL of local anesthesia plus a topical spray with ethyl chloride; group E received oral analgesia and anxiolysis 30 minutes before the procedure in addition to the group A dosage of lidocaine; and group F received the same anesthesia as did group A, but the BMAD was performed by a less experienced practitioner.

  Results

  On a 0 to 10 scale, the mean pain level among the 258 patients was 3.2 (standard deviation = 2.6). Rate of complications was low (<1%). Several strategies failed to improve the pain level, including the administration of a double dose of local anesthesia, waiting longer for the anesthesia effect, and the additional use of a topical anesthetic spray or oral analgesia and anxiolysis. Pain levels were not increased when the procedure was done by a less experienced practitioner. Younger age and female gender were associated with higher pain levels.

  Conclusions

  Given that the average level of perceived pain during BMAB is low to moderate (approximately 3 on a 0-10 scale), the routine use of conscious sedation for this procedure may not be indicated. Several strategies aimed at reducing the pain level, including doubling the dose of anesthesia and using an oral prophylactic regimen of analgesia and anxiolysis, failed to improve pain scores.

  *For a PDF of the full article click in the link to the left of this introduction.

Perceived Levels of Pain Associated with Bone Marrow Aspirates and Biopsies

• Giampaolo Talamo, MD; Jason Liao, PhD; Jamal Joudeh, MD; Nicholas E. Lamparella, DO; Hoang Dinh, PA; Jozef Malysz, MD; W. Christopher Ehmann, MD

  Abstract

  Background

  Little is known about the degree of pain experienced by patients undergoing a bone marrow aspiration and biopsy (BMAB).

  Objective

  To evaluate the effectiveness of several strategies aimed at reducing the pain score.

  Methods

  We conducted a retrospective analysis of 258 consecutive adult patients who underwent BMAB via 6 different approaches, the first 5 of which were performed by one physician. Group A received local anesthesia with 1% lidocaine hydrochloride (5 mL) and a 5-minute wait time before the procedure; group B received local anesthesia with a double dose (10 mL) of lidocaine; group C received 5 mL of local anesthesia with a 10-minute wait; group D received 5 mL of local anesthesia plus a topical spray with ethyl chloride; group E received oral analgesia and anxiolysis 30 minutes before the procedure in addition to the group A dosage of lidocaine; and group F received the same anesthesia as did group A, but the BMAD was performed by a less experienced practitioner.

  Results

  On a 0 to 10 scale, the mean pain level among the 258 patients was 3.2 (standard deviation = 2.6). Rate of complications was low (<1%). Several strategies failed to improve the pain level, including the administration of a double dose of local anesthesia, waiting longer for the anesthesia effect, and the additional use of a topical anesthetic spray or oral analgesia and anxiolysis. Pain levels were not increased when the procedure was done by a less experienced practitioner. Younger age and female gender were associated with higher pain levels.

  Conclusions

  Given that the average level of perceived pain during BMAB is low to moderate (approximately 3 on a 0-10 scale), the routine use of conscious sedation for this procedure may not be indicated. Several strategies aimed at reducing the pain level, including doubling the dose of anesthesia and using an oral prophylactic regimen of analgesia and anxiolysis, failed to improve pain scores.

  *For a PDF of the full article click in the link to the left of this introduction.

Physicians' Undecided Attitudes Toward Posthumous Reproduction: Fertility Preservation in Cancer Patients with a Poor Prognosis

• Gwendolyn P. Quinn, PhD; Caprice A. Knapp, PhD; Teri L. Malo, PhD; Jessica McIntyre, BA; Paul B. Jacobsen, PhD; Susan T. Vadaparampil, PhD

  Abstract

  Background

  The American Society for Clinical Oncology (ASCO) established guidelines for fertility preservation for cancer patients. In a national study of US oncologists, we examined attitudes toward the use of fertility preservation among patients with a poor prognosis, focusing on attitudes toward posthumous reproduction.

  Method

  A cross-sectional survey was administered via mail and Internet to a stratified random sample of US oncologists. The survey measured demographics, knowledge, attitude, and practice behaviors regarding posthumous reproduction and fertility preservation with cancer patients of childbearing age.

  Results

  Only 16.2% supported posthumous parenting, whereas the majority (51.5%) did not have an opinion. Analysis of variance indicated that attitudes toward posthumous reproduction were significantly related to physician practice behaviors and were dependent on oncologists' knowledge of ASCO guidelines.

  Conclusions

  Physician attitudes may conflict with the recommended guidelines and may reduce the likelihood that some patients will receive information about fertility preservation. Further education may raise physicians' awareness of poor-prognostic patients' interest in pursuing this technology.

  *For a PDF of the full article click in the link to the left of this introduction.

Physicians' Undecided Attitudes Toward Posthumous Reproduction: Fertility Preservation in Cancer Patients with a Poor Prognosis

• Gwendolyn P. Quinn, PhD; Caprice A. Knapp, PhD; Teri L. Malo, PhD; Jessica McIntyre, BA; Paul B. Jacobsen, PhD; Susan T. Vadaparampil, PhD

  Abstract

  Background

  The American Society for Clinical Oncology (ASCO) established guidelines for fertility preservation for cancer patients. In a national study of US oncologists, we examined attitudes toward the use of fertility preservation among patients with a poor prognosis, focusing on attitudes toward posthumous reproduction.

  Method

  A cross-sectional survey was administered via mail and Internet to a stratified random sample of US oncologists. The survey measured demographics, knowledge, attitude, and practice behaviors regarding posthumous reproduction and fertility preservation with cancer patients of childbearing age.

  Results

  Only 16.2% supported posthumous parenting, whereas the majority (51.5%) did not have an opinion. Analysis of variance indicated that attitudes toward posthumous reproduction were significantly related to physician practice behaviors and were dependent on oncologists' knowledge of ASCO guidelines.

  Conclusions

  Physician attitudes may conflict with the recommended guidelines and may reduce the likelihood that some patients will receive information about fertility preservation. Further education may raise physicians' awareness of poor-prognostic patients' interest in pursuing this technology.

  *For a PDF of the full article click in the link to the left of this introduction.

Physicians' Undecided Attitudes Toward Posthumous Reproduction: Fertility Preservation in Cancer Patients with a Poor Prognosis

• Gwendolyn P. Quinn, PhD; Caprice A. Knapp, PhD; Teri L. Malo, PhD; Jessica McIntyre, BA; Paul B. Jacobsen, PhD; Susan T. Vadaparampil, PhD

  Abstract

  Background

  The American Society for Clinical Oncology (ASCO) established guidelines for fertility preservation for cancer patients. In a national study of US oncologists, we examined attitudes toward the use of fertility preservation among patients with a poor prognosis, focusing on attitudes toward posthumous reproduction.

  Method

  A cross-sectional survey was administered via mail and Internet to a stratified random sample of US oncologists. The survey measured demographics, knowledge, attitude, and practice behaviors regarding posthumous reproduction and fertility preservation with cancer patients of childbearing age.

  Results

  Only 16.2% supported posthumous parenting, whereas the majority (51.5%) did not have an opinion. Analysis of variance indicated that attitudes toward posthumous reproduction were significantly related to physician practice behaviors and were dependent on oncologists' knowledge of ASCO guidelines.

  Conclusions

  Physician attitudes may conflict with the recommended guidelines and may reduce the likelihood that some patients will receive information about fertility preservation. Further education may raise physicians' awareness of poor-prognostic patients' interest in pursuing this technology.

  *For a PDF of the full article click in the link to the left of this introduction.

Acyclovir Prophylaxis Against Varicella Zoster Virus Reactivation in Multiple Myeloma Patients Treated With Bortezomib-Based Therapies: A Retrospective Analysis of 100 Patients

• Abhisek Swaika, MD; Aneel Paulus, MD/ Kena C. Miller; MSN, FNP; Tamur Sher, MD; Nikolaos G. Almyroudis, MD; Donna Ball, NP; Margaret Wood; MSN; Aisha Masood, MD; Kelvin Lee, MD; Asher A. Chanan-Khan, MD

  Abstract

  Background

  Previous studies have indicated that, in patients with multiple myeloma (MM), bortezomib is associated with an increased incidence of herpes zoster, resulting from reactivation of latent varicella zoster virus (VZV).

  Objective

  Our objective was to determine whether increased risk of VZV reactivation could be abrogated by using prophylactic acyclovir.

  Methods

  We retrospectively evaluated 100 consecutive MM patients treated with bortezomib-based therapies at the Roswell Park Cancer Institute for development of herpes zoster. Frontline and relapsed/refractory patients were included, and patients received bortezomib alone or in combination with agents such as doxorubicin, melphalan, or dexamethasone. All patients received >4 weeks of acyclovir prophylaxis (400 mg twice daily), which was initiated prior to starting treatment with bortezomib and discontinued 4 weeks following bortezomib.

  Results

  Median patient age was 62 years, 57% were male, and most (56%) had Durie-Salmon stage IIIA MM. None of the 100 MM patients receiving acyclovir prophylaxis developed herpes zoster during treatment with bortezomib, irrespective of patients receiving a wide variety of concomitant antimyeloma therapies and regardless of response to bortezomib-based therapy. One additional patient, found to be noncompliant with acyclovir therapy, experienced VZV reactivation, having received 3 cycles of bortezomib (3 weeks each cycle) in combination with cyclophosphamide and dexamethasone.

  Limitations

  Limitations of the study include its small size and retrospective nature.

  Conclusions

  The increased risk of VZV reactivation observed in previous studies of bortezomib-based therapy was completely abrogated in this series of patients who received prophylaxis with acyclovir.

  *For a PDF of the full article click in the link to the left of this introduction.

Acyclovir Prophylaxis Against Varicella Zoster Virus Reactivation in Multiple Myeloma Patients Treated With Bortezomib-Based Therapies: A Retrospective Analysis of 100 Patients

• Abhisek Swaika, MD; Aneel Paulus, MD/ Kena C. Miller; MSN, FNP; Tamur Sher, MD; Nikolaos G. Almyroudis, MD; Donna Ball, NP; Margaret Wood; MSN; Aisha Masood, MD; Kelvin Lee, MD; Asher A. Chanan-Khan, MD

  Abstract

  Background

  Previous studies have indicated that, in patients with multiple myeloma (MM), bortezomib is associated with an increased incidence of herpes zoster, resulting from reactivation of latent varicella zoster virus (VZV).

  Objective

  Our objective was to determine whether increased risk of VZV reactivation could be abrogated by using prophylactic acyclovir.

  Methods

  We retrospectively evaluated 100 consecutive MM patients treated with bortezomib-based therapies at the Roswell Park Cancer Institute for development of herpes zoster. Frontline and relapsed/refractory patients were included, and patients received bortezomib alone or in combination with agents such as doxorubicin, melphalan, or dexamethasone. All patients received >4 weeks of acyclovir prophylaxis (400 mg twice daily), which was initiated prior to starting treatment with bortezomib and discontinued 4 weeks following bortezomib.

  Results

  Median patient age was 62 years, 57% were male, and most (56%) had Durie-Salmon stage IIIA MM. None of the 100 MM patients receiving acyclovir prophylaxis developed herpes zoster during treatment with bortezomib, irrespective of patients receiving a wide variety of concomitant antimyeloma therapies and regardless of response to bortezomib-based therapy. One additional patient, found to be noncompliant with acyclovir therapy, experienced VZV reactivation, having received 3 cycles of bortezomib (3 weeks each cycle) in combination with cyclophosphamide and dexamethasone.

  Limitations

  Limitations of the study include its small size and retrospective nature.

  Conclusions

  The increased risk of VZV reactivation observed in previous studies of bortezomib-based therapy was completely abrogated in this series of patients who received prophylaxis with acyclovir.

  *For a PDF of the full article click in the link to the left of this introduction.

Acyclovir Prophylaxis Against Varicella Zoster Virus Reactivation in Multiple Myeloma Patients Treated With Bortezomib-Based Therapies: A Retrospective Analysis of 100 Patients

• Abhisek Swaika, MD; Aneel Paulus, MD/ Kena C. Miller; MSN, FNP; Tamur Sher, MD; Nikolaos G. Almyroudis, MD; Donna Ball, NP; Margaret Wood; MSN; Aisha Masood, MD; Kelvin Lee, MD; Asher A. Chanan-Khan, MD

  Abstract

  Background

  Previous studies have indicated that, in patients with multiple myeloma (MM), bortezomib is associated with an increased incidence of herpes zoster, resulting from reactivation of latent varicella zoster virus (VZV).

  Objective

  Our objective was to determine whether increased risk of VZV reactivation could be abrogated by using prophylactic acyclovir.

  Methods

  We retrospectively evaluated 100 consecutive MM patients treated with bortezomib-based therapies at the Roswell Park Cancer Institute for development of herpes zoster. Frontline and relapsed/refractory patients were included, and patients received bortezomib alone or in combination with agents such as doxorubicin, melphalan, or dexamethasone. All patients received >4 weeks of acyclovir prophylaxis (400 mg twice daily), which was initiated prior to starting treatment with bortezomib and discontinued 4 weeks following bortezomib.

  Results

  Median patient age was 62 years, 57% were male, and most (56%) had Durie-Salmon stage IIIA MM. None of the 100 MM patients receiving acyclovir prophylaxis developed herpes zoster during treatment with bortezomib, irrespective of patients receiving a wide variety of concomitant antimyeloma therapies and regardless of response to bortezomib-based therapy. One additional patient, found to be noncompliant with acyclovir therapy, experienced VZV reactivation, having received 3 cycles of bortezomib (3 weeks each cycle) in combination with cyclophosphamide and dexamethasone.

  Limitations

  Limitations of the study include its small size and retrospective nature.

  Conclusions

  The increased risk of VZV reactivation observed in previous studies of bortezomib-based therapy was completely abrogated in this series of patients who received prophylaxis with acyclovir.

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