Patients Undergoing Cancer Therapy Research Articles

Role of recombinant human erythropoietin in the treatment of cancer-related anaemia

Anaemia is one of the most frequently diagnosed complications in cancer patients and also occurs during the course of cancer treatment. The condition can be observed in as many as 60–70% of patients who receive chemotherapy or radiotherapy. As a cancer symptom, it is found in 30% of cases and is particularly severe when accompanied by kidney failure. In patients undergoing cancer therapy, anaemia is treated with PRBC transfusions and/or recombinant human erythropoietin. The article discusses 3 case studies of patients with late-stage cancer (pleural mesothelioma, urothelial kidney carcinoma, and lung carcinoma), who suffered from moderate to severe anaemia during aggressive treatment with chemo- and radiotherapy. All 3 patients were treated with erythropoietin, which made it possible for them to stay on chemotherapy and/or undergo radiotherapy. Thanks to erythropoietin, they did not require PRBC transfusions and their general condition and quality of life improved. They tolerated the treatment well and no complications were observed.

Screening-ul şI profilaxia parodontitei în prevenirea cancerului cavităţii orale şi a complicaţiilor acestuia

Periodontitis is a complex, multifactorial infectious disease, which affects a high proportion of the global population. Recent studies show that periodontal disease has strong negative impact on the homeostasis of the oral cavity but has also been associated with several systemic diseases. Although some correlation mechanisms between periodontitis and certain systemic disease have been described further extensive investigations are needed to establish causality. Periodontitis could be involved in the onset and progression of some types of cancers, especially oral cancer due to chronic inflammation. The release of citokines and inflammatory markers at a local level and in the blood stream can disregulate the variables of the body and can be directly involved in the mechanim of tumorigenesis. Another hypothesis relies on the role of disbiosis of the oral microbiome and the structural and functional alterations of the subgingival flora which define periodontitis in the oral cancer development. The prevalence of oral cancer is very high and continous increase at an alarming rate globally. The rapid progression and aggressive behavior of oral cancer, the high mortality rate, the comorbidities and negative effect on the quality of life after cancer treatment but most importantly the low survival rate on the long term highlight the need to supress all the potential risk factors in order to prevent this disease. Periodontal status evaluation and periodontal therapy should be initiated in patients undergoing cancer therapy in order to lower the risk of complications associated with radiation- and chemotherapy. Also on the long run treatment of periodontal disease could prevent the development of a new oropharyngial carcinoma.

Exercise interventions for patients with pediatric cancer during inpatient acute care: A systematic review of literature

Physical inactivity has been shown to exacerbate negative side effects experienced by pediatric patients undergoing cancer therapy. Exercise interventions are being created in response. This review summarizes current exercise intervention data in the inpatient pediatric oncology setting. Two independent reviewers collected literature from three databases, and analyzed data following the PRISMA statement for systematic reviews and meta-analyses. Ten studies were included, representing 204 patients. Good adherence, positive trends in health status, and no adverse events were noted. Common strategies included individual, supervised, combination training with adaptability to meet fluctuating patient abilities. We recommend that general physical activity programming be offered to pediatric oncology inpatients.

Psychometric Study of the Pain Drawing.

The objectives of the study were to (1) assess the extent to which interrater reliability of pain drawing location and dispersion scoring methods are similar across pain disciplines in a sample of patients with cancer treatment-induced neuropathic pain (N = 56) and (2) investigate indicators of validity of the pain drawing in this unique sample. Patients undergoing cancer therapy completed the Brief Pain Inventory Body Map, the MD Anderson Symptom Inventory, and the McGill Pain Questionnaire. Intraclass correlation coefficients among medical and psychology professionals ranged from .93-.99. Correlations between pain drawing score and symptom burden severity ranged from .29-.39; correlations between pain drawing score and symptom burden interference ranged from .28-.34. Patients who endorsed pain in the hands and feet more often described their pain as electric, numb, and shooting than patients without pain in the hands and feet. They also endorsed significantly more descriptors of neuropathic pain. Results suggest a similar understanding among members of a multidisciplinary pain team as to the location and dispersion of pain as represented by patients' pain drawings. In addition, pain drawing scores were related to symptom burden severity and interference and descriptors of neuropathic pain in expected ways.

Cardiac Complications of Cancer Therapy: Pathophysiology, Identification, Prevention, Treatment, and Future Directions.

Cardiotoxicity is an important complication of cancer therapy. With a significant improvement in the overall survival and prognosis of patients undergoing cancer therapy, cardiovascular toxicity of cancer therapy has become an important public health issue. Several well-established as well as newer anticancer therapies such as anthracyclines, trastuzumab, and other HER2 receptor blockers, antimetabolites, alkylating agents, tyrosine kinase inhibitors, angiogenesis inhibitors, checkpoint inhibitors, and thoracic irradiation are associated with significant cardiotoxicity. Cardiovascular imaging employing radionuclide imaging, echocardiography, and magnetic resonance imaging is helpful in early detection of the cardiotoxicity and prevention of overt heart failure. These techniques also provide important tools for understanding the mechanism of cardiotoxicity of these modalities, which would help develop strategies for the prevention of cardiac morbidity and mortality related to the use of these agents. An understanding of the mechanism of the cardiotoxicity of cancer therapies can help prevent and treat their adverse cardiovascular consequences. Clinical implementation of algorithms based upon cardiac imaging and several non-imaging biomarkers can prevent cardiac morbidity and mortality associated with the use of cardiotoxic cancer therapies.

Strategies for Overcoming Resistance in Tumours Harboring BRAF Mutations.

The development of resistance to previously effective treatments has been a challenge for health care providers and a fear for patients undergoing cancer therapy. This is an unfortunately frequent occurrence for patients undergoing targeted therapy for tumours harboring the activating V600E mutation of the BRAF gene. Since the initial identification of the BRAF mutation in 2002, a series of small molecular inhibitors that target the BRAFV600E have been developed, but intrinsic and acquired resistance to these drugs has presented an ongoing challenge. More recently, improvements in therapy have been achieved by combining the use of BRAF inhibitors with other drugs, such as inhibitors of the downstream effector mitogen activated protein kinase (MAPK)/extracellular-signal regulated kinase (ERK) kinase (MEK). Despite improved success in response rates and in delaying resistance using combination therapy, ultimately, the acquisition of resistance remains a concern. Recent research articles have shed light on some of the underlying mechanisms of this resistance and have proposed numerous strategies that might be employed to overcome or avoid resistance to targeted therapies. This review will explore some of the resistance mechanisms, compare what is known in melanoma cancer to colorectal cancer, and discuss strategies under development to manage the development of resistance.

Evaluation of resistance training to improve muscular strength and body composition in cancer patients undergoing neoadjuvant and adjuvant therapy: a meta-analysis.

Muscle atrophy and strength decline are two of the most prominent characteristics in cancer patients undergoing cancer therapy, leading to decreased functional ability and reduced quality of life. Therefore, the aim is to systematically review research evidence of the effects of resistance exercise (RE) on lower-limb muscular strength, lean body mass (LBM), and body fat (BF) in cancer patients undertaking neoadjuvant or adjuvant therapy. This research was conducted using the following online database: Clinical Trial Register, Cochrane Trial Register, PubMed, SPORT Discus, and SciELO, from September 2014 until May 2015. We used the following keywords in various combinations with a systematic search: "Cancer therapy," "Wasting muscle," "Muscle loss," "Muscle function," "Neoadjuvant therapy," "Adjuvant thera-py," "Resistance Training," "Weight training," and "Exercise." After selection of 272 full-text articles, 14 publications were included in this meta-analysis. Resistance exercise (RE) during neoadjuvant or adjuvant therapy increased lower-limb muscular strength (mean: 26.22kg, 95% CI [16.01, 36.43], heterogeneity: P=<0.01, I 2=76%, P=0.00001) when compared to controls over time. Similarly, lean body mass (LBM) increased (mean 0.8kg, 95% CI [0.7, 0.9], heterogeneity: P=0.99, I 2=0%, P<0.00001), and decreased body fat (BF) (mean: -1.3kg, 95% CI [-1.5, 1.1], heterogeneity: P=0.93, I2=0%, P<0.00001) compared to controls over time. RE is effective to increase lower-limb muscular strength, increase LBM, and decrease BF in cancer patients undergoing neoadjuvant and adjuvant therapy regardless of the kind of treatment. RE increases muscle strength, maintains LBM, and reduces BF in cancer patients undergoing adjuvant and neoadjuvant therapies. Cancer patients and survivors should consider undertaking RE as an effective countermeasure for treatment-related adverse effects to the musculoskeletal system.

Does Regular Exercise Counter T Cell Immunosenescence Reducing the Risk of Developing Cancer and Promoting Successful Treatment of Malignancies?

Moderate intensity aerobic exercise training or regular physical activity is beneficial for immune function. For example, some evidence shows that individuals with an active lifestyle exhibit stronger immune responses to vaccination compared to those who are inactive. Encouragingly, poor vaccine responses, which are characteristic of an ageing immune system, can be improved by single or repeated bouts of exercise. In addition, exercise-induced lymphocytosis, and the subsequent lymphocytopenia, is thought to facilitate immune surveillance, whereby lymphocytes search tissues for antigens derived from viruses, bacteria, or malignant transformation. Aerobic exercise training is anti-inflammatory and is linked to lower morbidity and mortality from diseases with infectious, immunological, and inflammatory aetiologies, including cancer. These observations have led to the view that aerobic exercise training might counter the age-associated decline in immune function, referred to as immunosenescence. This article summarises the aspects of immune function that are sensitive to exercise-induced change, highlighting the observations which have stimulated the idea that aerobic exercise training could prevent, limit, or delay immunosenescence, perhaps even restoring aged immune profiles. These potential exercise-induced anti-immunosenescence effects might contribute to the mechanisms by which active lifestyles reduce the risk of developing cancer and perhaps benefit patients undergoing cancer therapy.

Abstract P1-10-21: Voice of cancer patients: Analysis of concerns of patients receiving adjuvant chemotherapy for breast cancer

Abstract Introduction: There is a growing interest in understanding the concerns of patients undergoing cancer therapy. Many patients share their experiences on online support forums, which contain millions of freely shared messages that can be used to analyze patient concerns. Unfortunately, these data are unstructured, which makes them difficult to analyze. In this project we organize the data on these forums using methods from Big Data Science (BDS), and then analyze these data by creating a Decision Support System (DSS): an interactive interface that can be used by both patients and providers to understand patient concerns about their cancer therapies. Method: We collected approximately 10 million unique messages from 20 unrestricted breast cancer forums that provide information about diagnoses, treatments, side effects, supportive therapies, and specific experiences. After using domain knowledge of breast cancer to build custom ontologies for regimens, side effects, and supportive therapy, we use the following techniques from BDS in order to create our DSS: • Topic Modeling to find keywords that best represent a given theme • Information Retrieval to filter for messages that are related to this theme • Natural Language Processing to extract the relevant data from these messages • Token Windows and Co-occurrence-based Algorithms to associate regimens with their side effects and supportive therapies. To use the DSS, a user provides disease-related parameters and the treatment. The DSS then gives the percentage of messages discussing side effects for a similar cohort of patients and the percentage of messages that discuss supportive therapies for each of these side effects. Results: We retrieved 84938 messages from patients receiving adjuvant chemotherapy with the regimens listed below, and then analyzed the percentage of people mentioning each side effect. The results are summarized in the following table. Side-Effect DataSide-EffectAC/T, %C/T, %TCH, %AC, %AC/Taxotere, %FEC/Taxotere, %Pain56.651.45051.55756.4Neuropathy6.44.66.17.54.55.7Nausea12.611.213.414.51014.6Alopecia2.53.63.22.622.5Nail changes6.87.19.375.56.4Heart related17.820.4171817.416.4Fatigue8.69.88.610.57.99.2Swelling55.77.256.66.8Rash itching7.39.68.998.17.6Total count2109628788136971105872193080 These statistics reflect patient concern about a particular side effect, instead of the true incidence of that side effect. For example, although about 90% of patients receiving the above regimens experience alopecia, only between 2% and 4% of messages on online forums mention alopecia. Our system can also associate drugs to their side effects and suggest supportive therapies. For instance, 5428 (20.6%) of 26370 messages on Neulasta, mention it as the cause of bone pain. Out of these, 1262 (23.2%) mention Loratidine in context with Neulasta as a suggestion to alleviate bone pain (p &amp;lt; 0.00001). Conclusion: Using methods from BDS, our DSS reliably associates side effects to a particular drug or regimen and suggests a supportive therapy. Our results reflect the concerns of patients undergoing cancer therapy, which might help the medical community identify areas of resource allocation and unmet needs. Citation Format: Aggarwal S, Liu M, Sharma R, Gupta A, Singh D, Sharma R, Yang F, Basak A, Aggarwal A. Voice of cancer patients: Analysis of concerns of patients receiving adjuvant chemotherapy for breast cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-10-21.

Evaluation of Relationship Between Demographics and Dental Status in a Defined Group of Iranian Paediatric Patients Undergoing Cancer Therapy.

Cancer is a major cause of death in children under 15 years of age. This study aimed to evaluate relationship between demographics and dental status in a defined group of Iranian paediatric patients undergoing cancer therapy. This cross-sectional study was accomplished on 161 subjects age ranging 8-12 years. There were 76 cancerous patients hospitalized at Mahak Hospital (one of the major children's cancer centers in Tehran) as the study group and 85 healthy children attending at Dental School, International Branch of Shahid Beheshti University of Medical Sciences, Tehran, Iran from 2012 to 2013. Demographics were gathered by using data-form. Oral examination and DMFT Index were used to describe teeth status in all teeth and in the first permanent molars. According to Becker's definition, "D" stands for untreated decayed teeth, "M" indicates missing teeth, and "F" shows Filled teeth. It is noteworthy that full coverage crowns are considered as "F" in this Index. Chi-square, Mann-Whitney U, Student's t-tests and Logistic Regression were used for data analysis. The most frequent type of cancer was acute lymphoblastic/lymphocytic leukemia (33.3%). Patients were significantly shorter than controls (p=0.03), and their fathers and mothers were of lower educational achievement (p=0.01, p= 0.001). Although DMFT of all dentition showed significantly higher score in cancerous children (p=0.001), DMFT of four first permanent molars (left, right, upper, and lower) was borderline significantly higher in patients (p= 0.06). Moreover, frequency of cancer was borderline significantly higher in children with lower birth order (p= 0.05). According to Logistic Regression, in as much as patients grew elder 1 year, DMFT index increased 1.5 units. Patients under cancer therapy were shorter than healthy ones, and their parents were of lower educational levels. In addition, their teeth status was poorer than controls.

N-3 polyunsaturated fatty acids decrease levels of doxorubicin-induced reactive oxygen species in cardiomyocytes -- involvement of uncoupling protein UCP2

BackgroundUse of the chemotherapeutic drug doxorubicin (DOX) is associated with serious cardiotoxicity, as it increases levels of reactive oxygen species (ROS). N-3 polyunsaturated fatty acid dietary supplements can be of benefit to patients undergoing cancer therapy. The aims of this study were to determine whether DOX-induced cardiotoxicity is related to mitochondrial uncoupling proteins and whether eicosapentaenoic acid (EPA, C20:5 n-3) or docosahexaenoic acid (DHA, C22:6 n-3) affects DOX-induced cardiomyocyte toxicity.ResultsTreatment of H9C2 cells with DOX resulted in decreased cell viability and UCP2 expression. Treatment with 100 μM EPA or 50 μM DHA for 24 h resulted in a maximal mitochondria concentration of these fatty acids and increased UCP2 expression. Pretreatment with 100 μM EPA or 50 μM DHA prevented the DOX-induced decrease in UCP2 mRNA and protein levels, but these effects were not seen with EPA or DHA and DOX cotreatment. In addition, the DOX-induced increase in ROS production and subsequent mitochondrial membrane potential change (∆ψ) were significantly attenuated by pretreatment with EPA or DHA.ConclusionEPA or DHA pre-treatment inhibits the DOX-induced decrease in UCP2 expression, increase in ROS production, and subsequent mitochondrial membrane potential change that contribute to the cardiotoxicity of DOX.Electronic supplementary materialThe online version of this article (doi:10.1186/s12929-014-0101-3) contains supplementary material, which is available to authorized users.

Management of diabetes in patients with cancer.

Diabetes is common amongst patients with cancer. The co-occurrence of diabetes and cancer may lead to poorer prognosis and complications in patients undergoing cancer therapy. There is no randomized trial evidence that treating hyperglycaemia in patients with cancer improves outcomes, and therefore a pragmatic approach to managing hyperglycaemic in such patients is required. We discuss the management of hyperglycaemia in relation to cancer chemotherapy, glucocorticoids and enteral feeding. We also discuss management of glucose in diabetic patients with cancer approaching end of life care.

Long-term aerobic exercise protects against cisplatin-induced nephrotoxicity by modulating the expression of IL-6 and HO-1.

Nephrotoxicity is substantial side effect for 30% of patients undergoing cancer therapy with cisplatin and may force them to change or even abandon the treatment. Studies regarding aerobic exercise have shown its efficacy for the treatment of many types of diseases and its capacity to reduce tumors. However, little is known about the impact of physical exercise on cisplatin-induced acute kidney injury (AKI). In the present study, our aim was to investigate the role of physical exercise in AKI induced by cisplatin. We submitted C57Bl6 male mice to seven weeks of chronic exercise on a training treadmill and treated them with single i.p. injection of cisplatin (20 mg/kg) in the last week. Exercise efficacy was confirmed by an increased capillary-to-fiber ratio in the gastrocnemius muscle of exercised groups (EX and CIS-EX). The group submitted to exercise before cisplatin administration (CIS-EX) exhibited less weight loss and decreased serum urea levels compared to the cisplatin group (CIS). Exercise also showed a protective role against cisplatin-induced cell death in the kidney. The CIS-EX group showed a lower inflammatory response, with less TNF and IL-10 expression in the kidney and serum. In the same group, we observed an increase of IL-6 and HO-1 expression in the kidney. Taken together, our results indicate that chronic aerobic exercise is able to attenuate AKI by inducing IL-6 and HO-1 production, which results in lower inflammatory and apoptotic profiles in the kidney.

Bacillus Cereus Bacteremia and Multiple Brain Abscesses During Acute Lymphoblastic Leukemia Induction Therapy

Bacillus cereus can cause serious infections in immunosuppressed patients. This population may be susceptible to B. cereus pneumonia, bacteremia, cellulitis, and rarely cerebral abscess. Here we report an 8-year-old boy undergoing induction therapy for acute lymphoblastic leukemia who developed multifocal B. cereus cerebral abscesses, highlighting the propensity for B. cereus to develop cerebral abscesses. A review of the literature over the past 25 years identified another 11 cases (3 children and 8 adults) of B. cereus cerebral abscess in patients undergoing cancer therapy. B. cereus cerebral abscesses were associated with a high mortality rate (42%) and significant morbidity. Notably, B. cereus bacteremia with concomitant cerebral abscess was associated with induction chemotherapy for acute leukemia in both children and adults (10 of 12 case reports). Our case report and review of the literature highlights the propensity for B. cereus to develop cerebral abscess(es). Therefore, early consideration for neuroimaging should be given for any neutropenic cancer patient identified with B. cereus bacteremia, in particular those with acute leukemia during induction therapy.

The intestinal microbiota: a boost for antitumor treatments

Two new studies in mice, published in Science, show that the commensal bacteria populations in the gut play a key role in boosting responses to different antitumor regimens. These results argue for a rational use of antibiotics when managing infections in patients undergoing cancer therapies.

Microbiota and their role in the pathogenesis of oral mucositis

Oral mucositis in patients undergoing cancer therapy is a significant problem. Its prevalence ranges between 20 and 100%, depending on treatment type and protocols and patient-based variables. Mucositis is self-limiting when uncomplicated by infection. Unfortunately, the incidence of developing a local or systemic infection during the course of the treatment is very high. At this stage, it is unclear which role oral microbiota play in the onset, duration, and severity of oral mucositis. Nevertheless, there is growing interest in this underexplored topic, and new studies are being undertaken to unravel their impact on the pathogenesis of mucositis.

Pediatric Oncology 911: What Palliative Care and Hospice Providers Should Know About Caring for Children with Progressive Cancer (TH304)

1.Describe five common oncologic emergencies in pediatric patients who may be receiving home hospice services.2.Describe three challenges created by integrating palliative care and curative therapies.3.Describe evidence-based management strategies for five oncologic emergencies, including the use of surgery, chemotherapy, and radiation therapy. Childhood cancer remains the leading cause of death by disease for children and adolescents in the United States. Survival rates are widely variable. Although there have been improvements in the cure rates of some tumors, other tumors have long-term survival rates less than 20%. Palliative care is an essential part of caring for children with advanced cancer. The Patient Protection and Affordable Care Act signed into law in 2010 by President Obama contained a provision to provide simultaneous access to both curative therapy and hospice services for children insured through Medicaid and CHIP. This provision, termed the Concurrent Care for Children Requirement, has resulted in more children receiving aggressive disease directed therapies while simultaneously being cared for by hospice providers. It is important, therefore, for hospice providers to become more familiar with oncologic emergencies that may occur in patients undergoing cancer therapy because parent and patient goals might be to aggressively treat these emergencies and some emergencies may be reversible. Using a case based discussion, we intend to discuss management strategies for common oncologic emergencies, including increased intracranial pressure, superior vena cava syndrome, sepsis, spinal cord compression, and hyperleukocytosis. Available medical literature for treatment options will also be reviewed.

Oral Complications and Management Strategies for Patients Undergoing Cancer Therapy

With cancer survival rate climbing up over the past three decades, quality of life for cancer patients has become an issue of major concern. Oral health plays an important part in one's overall quality of life. However, oral health status can be severely hampered by side effects of cancer therapies including surgery, chemotherapy, radiotherapy, and hematopoietic stem cell transplantation. Moreover, prevention and treatment of these complications are often overlooked in clinical practice. The present paper aims at drawing health care professionals' attention to oral complications associated with cancer therapy by giving a comprehensive review. Brief comments on contemporary cancer therapies will be given first, followed by detailed description of oral complications associated with cancer therapy. Finally, a summary of preventive strategies and treatment options for common oral complications including oral mucositis, oral infections, xerostomia, and dysgeusia will be given.

National Survey of Oncology Members’ Knowledge, Education and Patient Management Regarding Oral Care in Cancer Therapy

Abstract INTRODUCTION Oral complications can be profound in patients undergoing cancer therapy, negatively impacting quality of life, and potentially postponing or disrupting treatment. While oncology team members seek to deliver op-timal oral care, evidence-based management of oral complications and knowledge in the provision of oral care poses a challenge to attaining satisfactory reductions in complications such as oral mucositis, xerostomia and rampant dental caries.METHODS A cross-sectional, random sample (N=2,000) of members of the Oncology Nursing Society were surveyed via a Web-based questionnaire to identify knowledge of oral care, oral health management practices and factors in u-encing provision of oral care for patients being treated for cancer. Frequencies were calculated for demographic and cat -egorical data. Education, years of experience, and comfort levels were measured and correlated to identi ed subscales of knowledge, management of oral complications, and use of evidence-based protocols for high-risk patients.RESULTS Over 75% of respondents reported

The oral management of oncology patients requiring radiotherapy, chemotherapy and/or bone marrow transplantation

Patients undergoing cancer therapy may experience unwanted side-effects involving the oral cavity and more evidence is emerging regarding the management of these complications. These oral effects have both short and long-term implications. Dentists need to be aware of these implications and liaise closely with the oncology teams to establish pathways of oral care. This enables patients to have appropriate dental support in place before, during and after cancer therapy. This article is an executive summary of a review undertaken for a national clinical guideline, The Oral Management of Oncology Patients following Radiotherapy, Chemotherapy and/or Bone Marrow Transplanation. The full text is available on the FDS website: www.rcseng.ac.uk/fds/publications-clinical-guidelines/clinical_guidelines/