Palliative and Supportive Care

The treatment of patients with acute myelogenous leukemia (AML) ranges from palliative care only, to standard therapy, to investigational approaches. Acute myelogenous leukemia is, in fact, several different diseases, and the percentage of clinical responses varies with disease and prognostic subsets.

The US Food and Drug Administration has approved Amgen’s pegfilgrastim (Neulasta) for use in decreasing the incidence of infection, as manifested by febrile neutropenia. The agent, administered in a single fixed dose per chemotherapy cycle, is indicated for patients with nonmyeloid malignancies who are receiving myelosuppressive chemotherapy associated with a significant incidence of febrile neutropenia.

Data from a phase II study of subcutaneous amifostine (Ethyol) presented at the 43rd annual meeting of the American Society for Therapeutic Radiology and Oncology suggested that subcutaneously administered amifostine may provide the same protective effects against radiation therapy-induced xerostomia as intravenous administration.

A new study found that lack of adherence to pain medication regimens and inadequate analgesic prescriptions are the main reasons cancer patients do not achieve adequate pain relief. The study observed cancer patients in their homes in order to determine whether they were adhering to the pain management regimens prescribed by their doctors. Researchers from the Schools of Nursing, Medicine, and Pharmacy at the University of California in San Francisco (UCSF) conducted the study, which was reported in the Journal of Clinical Oncology (19:4275-4279, 2001).

SAN FRANCISCO-For patients with metastatic breast cancer, adding weekly group therapy to standard care does not appear to improve survival, although psychological and other benefits are seen in certain patients, according to results of a

A federal judge in Oregon has temporarily blocked Attorney General John Ashcroft’s ability to prosecute Oregon physicians who use controlled substances to help a patient in pain end his or her life. Mr. Ashcroft’s announcement in early

Menopause can be experienced prematurely by women with cancer and, as such, is often accompanied by symptoms that are becoming salient management issues. It is common practice to avoid estrogen replacement therapy in women with estrogen-sensitive tumors.

Drug Enforcement Administration (DEA) Administrator Asa Hutchinson made an unusual appearance at the National Press Club on October 23 to call for a balanced policy on prescription pain medications such as oxycodone (OxyContin and

SAN DIEGO--Despite acknowledged oral complications associated with chemotherapy agents, there is nothing in the literature pointing to the causes.

Older individuals are at risk for adverse events in all settings where cancer is treated. Common geriatric syndromes can complicate cancer therapy, and thus, increase patient morbidity and the costs of care. Furthermore,

Cancer patients experience pain in multiple sites and from several pathophysiologies of the symptom complex. The fluctuating nature of cancer pain intensity is a relevant clinical feature and depends on disease patterns and pain mechanisms. Breakthrough pain is defined as episodes of pain that "break through" the control of an otherwise effective analgesic therapy.

The frequency of major fungal infections continues to increase, whether in association with increasing numbers of patients at risk due to under lying disease or its treatment, selection pressures related to increased use of broad-spectrum antimicrobials

ZUHL, Germany-Amifostine (Ethyol) used as cytoprotective therapy can reduce the occurrence of xerostomia, loss of taste, and fibrosis associated with radiochemotherapy for head and neck cancer. Jens Buentzel, MD, PhD, reported results of three studies at The First Investigators’ Congress on Radio-protection, held at the Kimmel Cancer Center at Jefferson University, Philadelphia. Dr. Buentzel is vice chairman of the Department of Otolaryngology, Head and Neck Oncology, Zentralklinikum Zuhl, Germany.

A steady increase in the frequency of invasive fungal infections has been observed in the past 2 decades, particularly in immunosuppressed patients. In recipients of bone marrow transplants, Candida albicans and Aspergillus fumigatus remain the primary pathogens. In many centers, however, Candida species other than C albicans now predominate, and many cases of aspergillosis are due to species other than A fumigatus. Additionally, heretofore unrecognized and/or uncommon fungal pathogens are beginning to emerge, including Blastoschizomyces capitatus, Fusarium species, Malassezia furfur, and Trichosporon beigelii. These opportunistic fungal pathogens are associated with various localized and disseminated clinical syndromes, and with substantial morbidity and mortality. These established, invasive mycoses, particularly in bone marrow transplant recipients, are the focus of this discussion. [ONCOLOGY 15(Suppl 9):11-14, 2001]

Efforts at preventing and treating fungal infection in hematopoietic stem cell transplant (HSCT) recipients must take into account the types of infections likely to be encountered during the different risk periods in hosts with different underlying risks. Given the emergence of molds as prevalent pathogens and the long duration of risk in allogeneic HSCT recipients, optimal antifungal prophylaxis would consist of treatment that can be given over a prolonged period and that would provide both anti-Candida and anti-Aspergillus activity. Optimal empiric therapy would consist of a broad-spectrum agent in the absence of more sensitive and specific methods for microbial diagnosis. Fluconazole (Diflucan) is currently the standard prophylactic agent for candidiasis, although mold-active agents and alternative strategies for polyene administration are being investigated. The gold standard for empiric therapy is currently a polyene antifungal, yet an increased appreciation for amphotericin B-resistant yeasts and molds, and less toxic mold-active alternatives, might lead to the use of other compounds in the future. The recent development of multiple alternatives emphasizes our need to establish treatment algorithms that consider both the likely pathogens and potential toxicities. [ONCOLOGY 15(Suppl 9):15-19, 2001]

Neuropathic pain may be defined as pain related to abnormal somatosensory processing in either the peripheral or central nervous system. This pathophysiologic label is typically applied when the painful symptom is associated

With the continuing increase in clinically important fungal disease, especially seen in the neutropenic patient, the need for new and improved systemic antifungal agents marches on. A pharmacy and therapeutics committee may select an antifungal agent based on these criteria: spectrum of action, pharmacokinetic profile, toxicity, potential for resistance, and cost. A number of agents are now available for treating deep fungal infections, including amphotericin B in conventional and liposomal formulations, and the triazoles itraconazole (Sporanox) and fluconazole (Diflucan). It is important to note that there is lack of agreement in practice over what constitutes ideal therapy. The lipid formulations of amphotericin B and the improved oral solution and new intravenous formulation of itraconazole are recent additions to therapeutic options that are already having a significant influence on drug selection and treatment practices. [ONCOLOGY 15(Suppl 9):21-25, 2001]

The availability of an improved oral solution and an intravenous (IV) formulation of itraconazole (Sporanox) promises to have an effect on prevention and treatment of fungal infection in immunocompromised patients. Use of itraconazole in neutropenic patients with hematologic malignancies has been evaluated in a number of European studies. Treatment with IV followed by oral itraconazole resulted in response or stable disease in two-thirds of patients with invasive pulmonary aspergillosis. Empiric treatment with IV followed by oral solution itraconazole was at least as effective as, and significantly less toxic than, amphotericin B. Several studies of oral solution prophylaxis indicate effectiveness in prevention of fungal infection. Oral solution and IV itraconazole are useful in a variety of situations in prophylaxis, empiric therapy, and treatment of probable/confirmed infection. Itraconazole exhibits a broad spectrum of activity against Aspergillus and Candida species. It has potential advantages over fluconazole (Diflucan), which does not exhibit in vitro activity against Aspergillus and most non-albicans Candida species, and amphotericin B, which is associated with a high incidence of toxicity. Aggressive use of itraconazole and amphotericin B preparations in treatment of fungal infection at Royal Free Hospital may have reduced mortality associated with aspergillosis. [ONCOLOGY 15(Suppl 9):27-32, 2001]

Anemia is a frequent complication of cancer and its associated treatment. Although its occurrence is well documented in the chemotherapy setting, the prevalence and nature of anemia in the radiation oncology setting

Pressure ulcers are a common problem, with about 1.5 to 3 million individuals in the United Stated affected. Treatment may be costly, requiring lengthy periods of hospitalization. Central to the development of pressure

In part I of this series, we identified currently active clinical trials that include health-related quality-of-life (HRQOL) outcomes as a primary or secondary objective of the overall study (Trimble EL et al: ONCOLOGY 15:601-611, 2001). The goal of this

The finding by a California jury in mid-June that a state physician was guilty of elder abuse and neglect because the physician undermedicated a terminal bone cancer patient gave new impetus to the Conquering Pain Act, a bill that was introduced by

Written by Jimmie C. Holland, MD, and Sheldon Lewis, this book focuses on the "human effects" as opposed to the

WASHINGTON-The nation needs to greatly improve the palliative and supportive care provided to cancer patients from diagnosis through death, according to a new report by the National Cancer Policy Board (NCPB), part of the National Academy of Sciences’ Institute of Medicine. The report made a series of recommendations intended to break down or lower the barriers to excellent care for people with cancer.

If he needed more encouragement than the California verdict, Sen.Wyden (D-Ore) got it a week later when the National

The Bayer Corporation announced recently that Viadur (leuprolide acetate implant), a once-yearly implant for the palliative

SAN FRANCISCO-The marijuana derivative dronabinol (Marinol) was significantly less effective than standard megestrol acetate at improving appetite and inducing weight gain in patients with advanced cancer. The results of a North Central Cancer Treatment Group (NCCTG)/Mayo clinic study also showed that combining the two drugs was no better than giving megestrol alone.

SAN FRANCISCO-A high-volume specialist palliative care unit (PCU) set up to improve end-of-life care for patients at Medical College of Virginia hospitals met patient goals for care and generated a profit for the hospital, despite caring for many indigent patients.

PONTE VEDRA BEACH, Fla-Walking 60 minutes or more a week could have a positive effect on fatigue and sleep disturbance in breast cancer patients, according to preliminary results presented by Barbara Poniatowski, MS, RNC, AOCN, at the Oncology Nursing Society’s Sixth National Conference on Cancer Nursing Research.

Researchers at Cedars-Sinai Medical Center report that very low doses of a potent new bisphosphonate, zoledronic acid (Zometa), reduces the complications arising from multiple myeloma and breast cancer that have metastasized to the bone. The