Targeted Drug Therapies: Beyond Blood Counts and Chemistries

Although the field of oncology pharmacotherapy has progressed rapidly with the introduction of novel targeted therapies, there are many unintended side effects that require knowledge of laboratory monitoring for appropriate m.

Oxaliplatin-Induced Pulmonary Fibrosis: A Rare but Fatal Reality

Oxaliplatin is a commonly used chemotherapy drug for the treatment of gastrointestinal malignancies, but it can lead to various side effects, including interstitial lung disease (ILD), a rare but potentially fatal condition. ILD is an inflammatory and fibrotic lung disease that can cause progressive lung damage and respiratory failure. The exact mechanism by which oxaliplatin induces ILD is not known, but it is believed to be due to an immune-mediated response, or direct toxicity via oxidative stress. The symptoms of oxaliplatin-induced ILD include cough, shortness of breath, fatigue, and weight loss. Diagnosis of oxaliplatin-induced ILD requires a high index of suspicion, and imaging tests such as chest X-rays and CT scans are used to confirm the diagnosis. Treatment options for oxaliplatin-induced ILD include corticosteroids, oxygen therapy, and early cessation of oxaliplatin therapy. Early detection and prompt management are crucial to improve the prognosis of patients with oxaliplatin-induced ILD.

Study of prevalence and risk factors of chemotherapy-induced mucositis in gastrointestinal cancer using machine learning models

Objective

Chemotherapy-induced mucositis (CIM) significantly impacts clinical outcomes and diminishes the quality of life in patients with gastrointestinal cancer. This study aims to prospectively determine the incidence, severity, and underlying risk factors associated with CIM in this patient population.

Methods

To achieve this objective, we introduce a novel Machine Learning-based Toxicity Prediction Model (ML-TPM) designed to analyze the risk factors contributing to CIM development in gastrointestinal cancer patients. Within the winter season spanning from December 15th, 2018 to January 14th, 2019, we conducted in-person interviews with patients undergoing chemotherapy for gastrointestinal cancer. These interviews encompassed comprehensive questionnaires pertaining to patient demographics, CIM incidence, severity, and any supplementary prophylactic measures employed.

Results

The study encompassed a cohort of 447 participating patients who provided complete questionnaire responses (100%). Of these, 328 patients (73.4%) reported experiencing CIM during the course of their treatment. Notably, CIM-induced complications led to treatment discontinuation in 14 patients (3%). The most frequently encountered CIM symptoms were diarrhea (41.6%), followed by nausea (37.8%), vomiting (25.1%), abdominal pain (21%), gastritis (10.5%), and oral pain (10.3%). Supplementary prophylaxis was administered to approximately 62% of the patients. The analysis revealed significant correlations between the overall incidence of CIM and gender (p=0.015), number of chemotherapy cycles exceeding one (p=0.039), utilization of platinum-based regimens (p=0.039), and administration of irinotecan (p=0.003). Specifically, the incidence of diarrhea exhibited positive correlations with prior surgical history (p=0.037), irinotecan treatment (p=0.021), and probiotics usage (p=0.035). Conversely, diarrhea incidence demonstrated an adverse correlation with platinum-based treatment (p=0.026).

Conclusion

In conclusion, this study demonstrates the successful implementation of the ML-TPM model for automating toxicity prediction with accuracy comparable to conventional physical analyses. Our findings provide valuable insights into the identification of CIM risk factors among gastrointestinal cancer patients undergoing chemotherapy. Furthermore, the results underscore the potential of machine learning in enhancing our understanding of chemotherapy-induced mucositis and advancing personalized patient care strategies.

Nursing Alchemy: Transforming R-CHOP Information Into Essentials

A combination of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) is a first-line combination chemotherapy regimen for diffuse large B-cell lymphoma that has many nursing implications. Understand.

A five arm natural history study of nasal vestibulitis

INTRODUCTION

Nasal symptoms are frequently reported by patients undergoing chemotherapy.

METHODS

Eligible patients planning to receive paclitaxel, docetaxel, nab-paclitaxel, bevacizumab without a concomitant taxane, or "other" (non-taxane, non-bevacizumab) chemotherapy regimens were invited to participate in this prospective study. Patients reported nasal symptoms prior to each dose of chemotherapy.

RESULTS

The percentage of patients (95% CI) who reported nasal symptoms was the same for patients who received bevacizumab or nab-paclitaxel, 82.6% (61.2%, 95.1%). There were no significant differences among the proportions of patients experiencing nasal symptoms within the paclitaxel, nab-paclitaxel, and bevacizumab cohorts. Patients in the nab-paclitaxel cohort were more likely to experience symptoms than those in the non-taxane non-bevacizumab cohort or docetaxel cohort (p = 0.001, p = 0.001). Patients in the bevacizumab cohort were more likely to experience nasal symptoms than those in the non-taxane non-bevacizumab cohort (p = 0.03).

CONCLUSION

Nasal vestibulitis symptoms are common in patients receiving chemotherapy, especially those receiving paclitaxel, docetaxel, and bevacizumab. Further investigations into treatments of this symptom complex are warranted.

Massage for Symptom Management in Adult Inpatients With Hematologic Malignancies

Background

Patients undergoing hematopoietic stem cell transplant often suffer from a predictable constellation of side effects related to therapy. Nonpharmacologic treatments for these side effects are attractive adjuncts to therapy due to a low side-effect profile.

Objective

To develop, implement, and evaluate a pilot program of massage therapy for symptom management in adult patients with hematologic malignancies admitted to the bone marrow transplant (BMT) service at a large academic medical center.

Methods

A single-arm feasibility study of massage therapy was conducted. Pre- and postintervention surveys were collected to assess the usefulness in management of 7 symptoms.

Results

Over an 11.5-month period, 109 patients received 142 massage treatments. one in five patients received more than one massage. We received surveys on 134 massage treatments. Patients reported significant reductions in anxiety, distress, fatigue, pain, and tension (P < .01) and improved sleep as a result of massage therapy.

Conclusion

Based on this pilot, massage therapy is a feasible and safe intervention to administer during BMT hospitalizations. It proved useful in managing a constellation of 5 side effects including, anxiety, distress, fatigue, pain, and tension.

Critical review of emergency department management of chemotherapy complications in cancer patients

INTRODUCTION

Recent worldwide advances in cancer therapies have resulted in an increased number of people receiving chemotherapy in ambulatory care settings. In Spain, emergency departments are the single point of entry to acute inpatient services and they play a pivotal role in the management of chemotherapy complications. Little research exists in patterns of emergency department utilisation by oncology patients with chemotherapy-related complications. However, it is important for the oncology patients and the healthcare system to gain understanding in the disease pathway and the organisational factors influencing the quality of care.

METHODS

This critical review's main aims were to describe the clinical characteristics of patients who presented to an emergency department after chemotherapy treatment as reported in international literature; to map reported patterns of care in emergency department access; and quality of care exploring the management of febrile neutropenic patients described in the literature, against best practice guidelines.

RESULTS

The search strategy yield 701 articles from MEDLINE, TROVE and SCOPUS and 26 were included. The review combines systematic reviews, observational, cross-sectional case-control studies and randomised control trials.

CONCLUSION

All articles showed areas and opportunities for improvement in the management of this population, especially with regard to time from triage to antibiotic administration in febrile neutropenic patients.

Patients' perception of chemotherapy side effects: Expectations, doctor-patient communication and impact on quality of life - An Italian survey

Chemotherapy side effects (CSE) have a strong impact on patients' quality of life (QOL). To assess patient perceptions of CSE, their impact on QOL and doctor-patient communication regarding these aspects, a survey was conducted among Italian cancer patients. Patients at least 18 years of age, who received chemotherapy, were administered a dedicated questionnaire to assess their point of view on five domains: expectations about CSE and impact on QOL; doctor-patient communication about CSE; treatments to reduce the impact of CSE; sexual life; family relationships/activities and employment. A total of 761 patients participated. CSE had a considerable impact on patient QOL. Nausea/vomiting was the most feared adverse effect before initiating chemotherapy and the one most commonly experienced during treatment. Patients generally reported good doctor-patient communication regarding information about CSE. In almost all cases, the oncologists prescribed an antiemetic treatment, but the incidence of nausea/vomiting was high. Cancer and CSE severely affected sexual life, daily activities and employment. CSE had a strong negative impact on QOL. Good doctor-patient communication is essential. Improving antiemetic strategies may improve QOL. Doctors' ability to inform patients about delicate issues, such as the impact of CSE on sexual life, needs to be improved.

Effect of Agaricus sylvaticus supplementation on nutritional status and adverse events of chemotherapy of breast cancer: a randomized, placebo-controlled, double-blind clinical trial

Background:

Breast cancer (BC) represents the highest incidence of malignancy in women throughout the world. Medicinal fungi can stimulate the body, reduce side-effects associated with chemotherapy and improve the quality of life in patients with cancer.

Aim:

To evaluate the effects of dietary supplementation of Agaricus sylvaticus on clinical and nutritional parameters in BC patients undergoing chemotherapy.

Materials and Methods:

A randomized, placebo-controlled, double-blind, clinical trial was carried out at the Oncology Clinic, Hospital of the Federal District-Brazil from September 2007 to July 2009. Forty six patients with BC, Stage II and III, were randomly assigned to receive either nutritional supplement with A. sylvaticus (2.1 g/day) or placebo. Patients were evaluated during treatment period.

Results:

Patient supplemented with A. sylvaticus improved in clinical parameters and gastrointestinal functions. Poor appetite decreased by 20% with no changes in bowel functions (92.8%), nausea and vomiting (80%).

Conclusion:

Dietary supplementation with A. sylvaticus improved nutritional status and reduced abnormal bowel functions, nausea, vomiting, and anorexia in patients with BC receiving chemotherapy.

Potential chemotherapy side effects: what do oncologists tell parents?

BACKGROUND

In order to determine the number of short-term side effects and late effects discussed during an informed consent conference (ICC) after the diagnosis of acute leukemia, we observed the occurrence(s) and the ratio between short-term side effects versus late effects during an ICC.

PROCEDURE

ICC(s) of childhood leukemia trials were audio-taped at six different study sites. The side effects mentioned during each of these ICC(s) were coded and analyzed.

RESULTS

One hundred forty cases were reviewed, from which we coded a total of 3,173 acute side effects and 242 late effects. The mean total side effects mentioned during each ICC was 24 (range 5-47). The number of late effects coded were significantly less than acute side effects. We also found that the duration of ICC(s) was positively correlated with the number of side effects mentioned. In addition, the frequency of total side effects mentioned was independent of patient or parent demographic factors.

CONCLUSIONS

Our results show that acute side effects are often mentioned but the discussion of late effects is much less frequent in the initial ICC(s). Careful consideration regarding the ratio of acute and late effects that are communicated to parents in the context of the ICC may facilitate parental understanding of clinically relevant side effects.