Abstract: Improved understanding as to the biology of multiple myeloma (MM) and the bone marrow microenvironment has led to the development of new drugs to treat MM. This explosion of new and highly effective drugs has led to dramatic advances in the management of MM and underscores the need for supportive care. Impressive and deep response rates to chemotherapy, monoclonal antibodies, and small molecule drugs provide hope of a cure or prolonged remission for the majority of individuals. For most patients, long-term, continuous therapy is often required to suppress the malignant plasma cell clone, thus requiring clinicians to become more astute in assessment, monitoring, and intervention of side effects as well as monitoring response to therapy. Appropriate diagnosis and monitoring strategies are essential to ensure that patients receive the appropriate chemotherapy and supportive therapy at relapse, and that side effects are appropriately managed to allow for continued therapy and adherence to the regimen. Multiple drugs with complex regimens are currently available with varying side effect profiles. Knowledge of the drugs used to treat MM and the common adverse events will allow for preventative strategies to mitigate adverse events and prompt intervention. The purpose of this paper is to review updates in the diagnosis and management of MM, and to provide strategies for assessment and monitoring of patients receiving chemotherapy for MM.
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Objectives: Fatigue is one of the most common complications of cancer and its related medications including chemotherapy. The present study aimed to investigate the effects of reflexology on the fatigue in cancer patients receiving chemotherapy. Materials and Methods: The current randomized clinical trial was conducted on 80 cancer patients under chemotherapy in Tohid Medical Center affiliated with Kurdistan University of Medical Sciences in Iran during 2016-2017. The patients were randomly assigned to control and intervention groups in the form of quadruple blocks using the StatsDirect software. The data were collected by a personal information questionnaire and the fatigue severity scale (FSS). After questionnaire administration and collection, foot sole reflexology was performed on the intervention group during four consecutive days each session lasting for 30 minutes. Then, the severity of fatigue was once more measured in the patients of both groups. Results: Based on the results, the mean and standard deviation in the investigated patients, before and after the intervention was 5.538±1.041 and 4.486±1.040 in the intervention group, respectively, indicating that the difference was significant (P = 0.000). In addition, after the reflexology was performed, the mean and standard deviation of the intervention and control groups were 4.486±1.040 and 5.180±1.450, respectively, which demonstrated a significant difference between the two groups in terms of fatigue (P = 0.016).
This systematic review included prospective trials with lamivudine for prophylaxis against HBV reactivation in patients on chemotherapy. PubMed and MEDLINE databases were searched to identify suitable trials for inclusion in the analysis. Eligible trials were examined and variables (which included rates of hepatitis, HBV reactivation, HBV- related mortality, mutations that confer lamivudine resistance and adverse events) were assessed. Hepatitis was defined as a greater than threefold increase in baseline aminotransferase levels to above the upper limit of normal (58 IU/l) or an absolute increase of 100 IU/l compared with baseline. HBV reactivation was defined as a 10-fold increase in HBV DNA levels compared with baseline or an absolute increase of >1 10 9 copies/ml in HBV DNA levels.
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Methods: Using data from a large private multi-payer health insurance claims database (2000-2006), we identified all patients beginning chemotherapy for metastatic lung cancer. Healthcare resource use (inpatient, outpatient, medications) and costs were tallied over time from date of therapy initiation ("index date”) to date of disenrollment from the health plan (in most instances, presumably due to death) or the end of the study period, whichever occurred first. Healthcare utilization and costs were characterized using Kaplan-Meier sample average methods. Results: The study population consisted of 4068 patients; mean (SD) age was 65 (11) years. Over a median follow- up of 334 days, study subjects averaged 1.5 hospital admissions, 8.9 total inpatient days, and 69 physician office and hospital outpatient visits. Mean (95% CI) cumulative total healthcare costs were $125,849 ($120,228, $131,231). Costs of outpatient medical services and inpatient care constituted 34% and 20% of total healthcare costs, respectively; corresponding estimates for outpatient chemotherapy and other medication were 22% and 24%. Conclusion: Our study sheds additional light on the burden of metastatic lung cancer among patients receiving chemotherapy, in terms of total cost thru end of life as well as component costs by setting and type of service, and may be useful in informing medical resource allocation in this patient population.
among patients was 78 years (range 66–103 years). The majority of patients were white (91.9%), male (78%), and married at the time of diagnosis (62.4%). The greatest proportion of cases lived within the greater California and New Jersey SEER registries. Some form of chemotherapy was administered to 727 (44.7%) of patients, and those receiving chemotherapy were significantly younger at time of diagnosis, white, married, and living in higher-education and -income census tracts. Approximately 45% of patients had one or more comorbidities identified in the 12 months prior to diagnosis. Expectedly, the majority of patients were diagnosed with malignant pleural mesothelioma (94.2%), with an epithelial histology (30.6%), and AJCC stage IV disease (29.1%). Patients receiving chemotherapy were more likely than those not receiving chemotherapy to have been diagnosed with AJCC stage II, III, or IV disease (71.3%), and less likely to have comorbid conditions compared to patients not receiving any chemotherapy. Mesothelioma clinical characteristics were also strongly predictive of multimodal treatment (chemotherapy and therapeutic surgery).
To sum up the literature review, it is an urgency to downsize the number of drug-induced hematological toxicity especially leucopenia and neutropenia in our population from who were diagnosed breast cancer receiving cyclophosphamide, adriamycin/epirubicin and fluorouracyl regimens (CAF/CEF). This study conducted by aiming to determine the influence of genetic variance in the GSTP1 gene involved in detoxification of cyclophosphamide active metabolite could affect susceptibility on the incidence and severity of hematologic toxicity after cyclophosphamide chemotherapy.
Prognostic factors for locally advanced breast cancer are, in general, similar to those for breast cancer at other stages. Tumor size and site of regional lymph node metastasis (i.e., axillary, infraclavicular, supraclavicular, or internal mammary), which make up the basis of the current staging system, have the greatest impact on disease recurrence and survival 24 . There is a strong association between survival rates and number of involved nodes, with one study reporting 5-year survival of 73% for patients with metastases in one to three lymph nodes, compared with 46% for patients with metastases in four or more nodes 25 . The vast majority of these patients did not receive chemotherapy. Increasing size of the primary tumor also has prognostic significance for patients with breast cancer, even in women with tumors larger than 5 cm in diameter 26 . Data from the San Antonio database indicate that patients with tumors measuring 5 to 6 cm in diameter have a 5-year disease-free survival rate of 72%, compared with 57% for patients with tumors larger than 6 cm. Tumor expression of ER and/or PR is generally considered a weak favorable prognostic factor and is highly predictive for response to hormonal treatment. HER2/ neu- positive versus HER2/neu-negative status has been associated with a poorer prognosis in patients with lymph node–positive disease in the majority of studies 27
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Mucositis develops in 4 phases: initiation, message generation, signal amplification, ulceration, and healing phase. Phase I: Initial inflammatory or vascular phase. During this phase, exposed cells in the buccal mucosa release free radicals, modified proteins, and proinflammatory cytokines, prostaglandins, and tumor necrosis factor (TNF). These are inflammatory mediators, which can cause further damage either directly or indirectly by increasing vascular permeability, thereby enhancing cytotoxic drug uptake (Toscano et al.,). Phase II: Epithelial phase: In this phase, chemotherapy radiation retards cell division in the oral mucosal epithelium, leading to reduced epithelial turnover and renewal resulting in epithelial breakdown. At this stage, microtrauma from activities such as speech, swallowing and mastication leads to ulceration. Phase III: Ulcerative/bacteriological phase (pseudomembraneous): Epithelial breakdown ultimately results in the ulcerative phase, which occurs within 1 week of therapy. Loss of epithelia and furious exudation lead to the formation of pseudomembranes and ulcers. In this phase, microbial colonization of damaged mucosal surfaces and yeast occurs then exacerbated by concomitant neutropenia. Neutropenic bone marrow transplantation recipients have infectious complications arising in neutropenic bone marrow and these are among the most challenging aspects of aggressive myelosuppressive antineoplastic drug therapy. Number of cases report that demonstrate the importance of ulcerative mucositis as an etiologic factor in the development of systemic a- hemolytic streptococcal infections in the neutropinic cancer patients (Epstein, 2003). Phase IV: Healing phase: This phase lasts usually from 12 to 16 days and mainly depends on factors such as epithelialproliferation rate, hematopoietic recovery and reestablishment of the local microbial flora (López, 2014).
Secondary endpoints are the of number of PRBC trans- fused up to 1 month after discharge, cost-effectiveness analysis; the number of patients with grade 3 or 4 bleeding, the number of patients with each complication defined in the primary endpoint, the number of transfu- sion- related events, number of days with hemoglobin level > 8 g/dL quality of life, duration of neutropenia, the time from randomization to last transfusion, the difference between the hemoglobin level immediately before and the day after transfusion, and the number of transfusion events without respect of the randomization arm. Transfusion- related events are defined as any complication declared by the physician to be related to the transfusion (fever, infec- tion, pulmonary edema, etc.). Quality of life will be assessed using the FACT and QLC30 questionnaires. Neu- tropenia duration is the time spent with an absolute neu- trophil count < 0.5 10 9 /L.
In our study, most of the GCSF administration as primary prophylaxis lasted less than seven days. The majority of patients (32.7%) had ANC recovery in 4- 7 days, which is comparable with other studies such as Sheridan et al. 16 and Carbonero et al. 17 . Most of our patients (N=34) had a hematological malignancy which usually takes longer time to recover compared with solid tumors. 18 Delayed ANC recovery was associated with longer periods of hospitalization which not only increase the cost, but also adversely affect the outcome. In our study, three (7%) patients took longer than 7 days for ANC to recover and hence had longer hospital stays, which is acceptable.
The serum levels of CA19.9 and sCD40L were analyzed before therapy (baseline) and after 3 months at first evalua- tion (for all patients). For 18 patients with partial response (PR) or stable disease (SD) at first evaluation, the sCD40L serum levels were also available and therefore analyzed at time to progression. A correlation between the serum levels of sCD40L and CA19.9 was also performed. The study was approved by the ethics committee of the National Cancer Research Centre, Istituto Tumouri “Giovanni Paolo II”, Bari, Italy, and written informed consent was obtained from all the patients enrolled in the study.
Abstract: Objective: To observe the efficacy of biweekly cetuximab combined with first-line chemotherapy for the treatment of KRAS/RAS wild-type advanced colorectal cancer. Methods: A retrospective study was performed in 72 patients with KRAS/RAS wild-type advanced colorectal cancer, confirmed by gene detection. According to the regiments the patients received, they were divided into the biweekly cetuximab group and the weekly cetuximab group, with 36 cases in each group. Patients in the two groups were assigned in two subgroups, left-sided colorectal cancer and right-sided colorectal cancer, according to the primary site of tumor. The efficacy and side effects in the two groups were evaluated. Results: In terms of efficacy, the objective remission rate was better in the biweekly cetuximab group than that in the weekly cetuximab group (P<0.05). The difference in overall survival time was not significant between the two groups (P>0.05). The objective remission rate, disease control rate and overall survival time in the two left-sided colorectal cancer subgroups were higher than those in the right-sided colorectal cancer subgroups (all P<0.05). In terms of adverse reactions, only the incidence of rash was higher in the biweekly cetux- imab group than in the weekly cetuximab group (P<0.05). Conclusion: Biweekly cetuximab combined chemotherapy has significant curative effects on patients with KRAS/RAS wild-type advanced colorectal cancer. The biweekly regimen is more beneficial and safer for the left colon, which is worthy of clinical application and further research.
Most articles suggest a difference in severity grading between OM during chemotherapy and OM in the course of radiotherapy [21-23]. In our sample, the three groups of alkylating agents (with Melphalan, with Busulfan and with other drugs) were differently related to the manifes- tation of OM: the Busulfan regimen was associated with a greater risk of oral mucositis than the other alkylant agents. Several articles discuss the incidence and gravity of OM during alkylant regimens. Wardley and co-workers  reported that Melphalan protocols (High Dose Mel- phalan and High Dose Melphalan-Total Body Irradiation) and regimens involving Busulfan were associated with a grave mucositis (grade 3, WHO). No subject enrolled in our survey underwent total body irradiation. Rapoport
In this cross-sectional study, partners of cancer patients receiving outpatient chemotherapy were consecutively recruited between July 2012 and March 2014. The participants completed a self-administered questionnaire survey at the De- partment of Medical Oncology at Toranomon Hospital in Tokyo, Japan (ap- proximately 2000 chemotherapy sessions are carried out on outpatients per year, and the number of admission is approximately 370 per year). Toranomon Hos- pital is the general hospital founded by Federation of National Public Service Personnel Mutual Aid Associations, which has 868 beds and approximately 2700 outpatients per day. This study was approved by the Medical Research Ethics Committee of Tokyo Medical and Dental University (1322) and the Institutional Review Board and Ethics Committee of Toranomon Hospital (595). Written in- formed consent was obtained from all partners who participated in the study.
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In this survey 32% of patients seen on the prespecified day were observed to be anemic, but there was only evidence of ESA use in approximately one-third of these. It is, however, possible that some patients with low hemoglobin levels may have had an ESA prescribed shortly after the office visit, which would not have been captured by the current study design. Nonetheless, these data suggest that, in line with previous studies, a significant proportion of patients with anemia, who could be treated with ESA according to EORTC or the ASCO and the ASH guidelines, may still not be receiving treatment.
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In the view of discussion above, the first cycle absolute neutrophil counts nadir provides useful information on the risk of future neutropenia, febrile neutropenia and dose delay or reduction. Other factors, such as pretreat- ment absolute neutrophil count, number of involved LN, pretreatment platelet count and first cycle platelet nadir can be used to predict occurrence of neutropenic com- plications in breast cancer patients undergoing chemo- therapy. Further studies among different populations with different tumor types and different treatment regimens are needed to confirm the results and explore other fac- tors which may contribute to occurrence of neutropenic complications.
Cancer represents a major health burden worldwide. A major source of this burden lies in the current difficulties associated with the prevention, diagnosis and treatment of different types cancers. In terms of treatment, there are different methods available including surgery, chemotherapy, radiation therapy, immunotherapy, monoclonal antibody therapy and hormone therapy. Chemotherapy in particular is widely used as a method to destroy cancer cells in affected patients. However, side effects to chemotherapeutic agents can emerge in patients due to the damage incurred to normal healthy cells and tissue during treatment. The range of side effects of chemotherapy are broad and can include nausea and vomiting, diarrhea or constipation, malnutrition, hair loss, memory loss, myelosupression, infections and sepsis, weight loss and hemorrhage 1 . Treating these side effects in affected patients represents a significant challenge to health care professionals in this area.
We observed an increase in invasive Leptotrichia infections at ARUP in 2007, followed by a subsequent rise in our own hospital in 2008. The reasons for this are probably multifactorial. First, regular use of 16S rRNA partial gene sequencing significantly ex- pands the number of anaerobic organisms that can be accurately identified (10, 16). It is also well recognized that Leptotrichia are not reliably identified by a commonly used phenotypic identifica- tion system (RapID ANA II; Remel, Lenexa, KS) (12, 14). Further- more, the number of at-risk patients has also expanded in recent years with the routine use of high-dose cytotoxic chemotherapy for HSCT and the treatment of other malignancies. In recognition of the increasing numbers of auto-HSCT patients admitted with severe mucositis, enteric bacteremia, and sepsis, antimicrobial prophylactic strategies were revised at our institution in 2009. These revisions may account for the subsequent decline in Lepto- trichia infections from our transplant center in 2010 (Fig. 1).
Abstract: Prevention of chemotherapy-induced nausea and vomiting (CINV) is a key component of treatment for patients with cancer. Guidelines are available to assist prescribers in the manage- ment of CINV associated with single-day chemotherapy regimens. However, currently there are no clear guidelines for management of CINV in patients receiving multiple-day chemotherapy regimens. Serotonin (5-HT 3 ) receptor antagonists are a mainstay in preventing CINV, and palonosetron, given its longer half-life and duration of action relative to other 5-HT 3 receptor antagonists, may be a useful option for managing CINV in multiple-day chemotherapy. Here we provide an overview of CINV and CINV treatment options, with a focus on palonosetron. We describe existing challenges in managing CINV, and discuss two patients receiving multiple-day chemotherapy, in whom CINV was managed successfully with palonosetron.
There have been several studies focusing on the relationship between patient's FoR and treatment modality, however the ﬁndings varied. A previous systematic review by Simard et al.  reported a weak to moderate association between treatment type (surgery/che- motherapy/radiotherapy) and FoR, and a recent meta-analysis con- ﬁ rmed a weak but signi ﬁ cant relationship between patient's FoR and the receipt of radiation treatment . However, several researchers [12–16] reported heterogeneous results that treatment type was not related to patients' FoR. Moreover, Llewellyn et al.  and Custers et al.  reported that FoR had no association with any socio- demographic or treatment/clinical variables. Even though many studies have investigated the link between cancer patient's FoR and the receipt of chemotherapy (CTX), they failed to demonstrate conclusive ﬁ ndings. However, as one of the major types of cancer treatment, studies found that patients with CTX are at higher risk of getting psychological problems, such as depression  and symptom distress . In addition, study showed that adverse eﬀects caused by CTX can contribute to greater FoR .