A case-control study assessing bone mineral density in severe haemophilia A in the UK

It has been shown that bone mineral density (BMD) may be lower in patients with haemophilia (PWH). A comparison to control subjects is required to thoroughly assess current BMD in PWH in the UK. The objective of this study was to test the hypothesis that BMD is lower in PWH than in controls, and in patients with more severely affected joints or lower activity levels. In this case-control study, 37 patients with severe haemophilia A were recruited from two haemophilia centres in the UK. A group of 37 age, gender and ethnicity-matched control participants were recruited. All participants had a bone density scan, a musculoskeletal assessment, a blood test for vitamin D and completed a functional activity questionnaire. Of the case group, 5% had osteoporosis and 24% had BMD lower than expected for age. No control participants had osteoporosis, 3% had osteopenia and 14% had BMD lower than expected for age. Ninety one per cent of case participants and 92% of control participants had reduced 25(OH)D levels. Case participants had significantly lower BMD than control participants, and case participants with more severely affected joints, lower activity levels, HIV, history of hepatitis C or lower BMI had significantly lower BMD. Patients with severe haemophilia have a higher risk of low BMD than men without haemophilia. Patients with more severely affected joints and lower activity levels have lower BMD. It remains unclear whether patients with low BMD reached adequate peak bone mass. Low vitamin D may be present in the majority of PWH.

Factors associated with delayed time to adjuvant chemotherapy in stage iii colon cancer

BACKGROUND

Adjuvant chemotherapy started more than 56 days after colon cancer resection has been associated with lesser overall survival among patients with stage iii colon cancer. The objective of the present population-based study was to determine, in referred patients with resected stage iii colon cancer, factors associated with delayed time to adjuvant chemotherapy (ttac), defined as more than 56 days from the date of surgery.

METHODS

Eligible patients had been diagnosed with stage iii colon cancer and had received at least 1 cycle of adjuvant chemotherapy at one of the four regional cancer treatment sites during 2008-2009. Prognostic and treatment information was prospectively collected through the BC Cancer Agency's GI Cancers Outcomes Unit, and Charlson comorbidity score was retrospectively determined by chart review. Chi-square and Wilcoxon rank-sum tests were used to measure associations between the timing of adjuvant chemotherapy and select prognostic and treatment variables.

RESULTS

Median ttac from surgery for the 395 included patients was 58 days, with 54% of the patients receiving adjuvant chemotherapy beyond the recommended 56 days. On multivariate analysis, only treatment at the highest-volume site was independently associated with delayed ttac. Comorbidity index, age, performance status, T stage, tumour location, and oral chemotherapy (compared with intravenous) were not independently associated with delayed ttac. Delays were observed during each interval associated with the patient's transition from surgery to first cycle of adjuvant chemotherapy.

CONCLUSIONS

More than half the patients failed to receive adjuvant chemotherapy within the recommended ttac of 56 days. Delayed ttac was associated with process-related delays rather than with patient- or disease-related factors. Efforts to improve timely referral, triage of consultations, and chemotherapy wait lists are required.

A phase II study of erlotinib in gemcitabine refractory advanced pancreatic cancer

BACKGROUND

Erlotinib induced skin toxicity has been associated with clinical benefit in several tumour types. This phase II study evaluated the efficacy of erlotinib, dose escalated to rash, in patients with advanced pancreatic cancer previously treated with gemcitabine.

METHODS

Erlotinib was given at an initial dose of 150 mg/day, and the dose was escalated by 50mg every 2 weeks (to a maximum of 300 mg/day) until >grade 1 rash or other dose limiting toxicities occurred. Erlotinib pharmacokinetics were performed, and baseline tumour tissue was collected for mutational analysis and epidermal growth factor receptor (EGFR) expression. The primary end-point was the disease control rate (objective response and stable disease >8 weeks).

RESULTS

Fifty-one patients were accrued, and 49 received treatment. Dose-escalation to 200-300 mg of erlotinib was possible in 9/49 (18%) patients. The most common ⩾ grade 3 adverse events included fatigue (6%), rash (4%) and diarrhoea (4%). Thirty-seven patients were evaluable for response, and the best response was stable disease in 12 patients (32% (95% confidence interval (CI) 17-47%)). Disease control was observed in nine patients (24% (95% CI: 10-38%)). Median survival was 3.8 months, and 6 month overall survival rate was 32% (95% CI 19-47%). Mutational analysis and EGFR expression were performed on 29 patients, with 93% having KRAS mutations, none having EGFR mutations, and 86% expressing EGFR. Neither KRAS mutational status nor EGFR expression was associated with survival.

CONCLUSIONS

Erlotinib dose escalated to rash was well tolerated but not associated with significant efficacy in non-selected patients with advanced pancreatic cancer.

Eastern Canadian Colorectal Cancer Consensus Conference: standards of care for the treatment of patients with rectal, pancreatic, and gastrointestinal stromal tumours and pancreatic neuroendocrine tumours

The annual Eastern Canadian Colorectal Cancer Consensus Conference was held in Halifax, Nova Scotia, October 20-22, 2011. Health care professionals involved in the care of patients with colorectal cancer participated in presentation and discussion sessions for the purposes of developing the recommendations presented here. This consensus statement addresses current issues in the management of rectal cancer, including pathology reporting, neoadjuvant systemic and radiation therapy, surgical techniques, and palliative care of rectal cancer patients. Other topics discussed include multidisciplinary cancer conferences, treatment of gastrointestinal stromal tumours and pancreatic neuroendocrine tumours, the use of folfirinox in pancreatic cancer, and treatment of stage ii colon cancer.

Cotton fever: an evanescent process mimicking sepsis in an intravenous drug abuser

BACKGROUND

Although many complications of intravenous drug abuse are well described, "cotton fever" has had little mention in recent medical literature. Cotton fever is street terminology for the post-injection fever experienced by many drug users after "shooting up" with heroin reclaimed from a previously used cotton filter.

CASE REPORT

We report on a 22-year-old man with a history of intravenous drug abuse with fever 30 min after injecting heroin. He was intensely diaphoretic, tachycardic, and febrile. His workup was negative for any infectious etiology and he later admitted to reusing the same cotton balls for heroin filtration several times over in order to preserve more of the drug.

CONCLUSIONS

Although it is usually a benign situation, cotton fever can have a dramatic clinical and hematologic course. We present a typical case of cotton fever followed by a description of the pathophysiology and clinical presentation of this entity.

Eastern Canadian colorectal cancer consensus conference: application of new modalities of staging and treatment of gastrointestinal cancers

The annual Eastern Canadian Colorectal Cancer Consensus Conference was held in Ottawa, Ontario, October 22-23, 2010. Health care professionals involved in the care of patients with colorectal cancer participated in presentation and discussion sessions for the purpose of developing the recommendations presented here. This consensus statement addresses current issues in the management of colorectal cancer, such as the use of epidermal growth factor inhibitors in metastatic colon cancer, the benefit of calcium and magnesium with oxaliplatin chemotherapy, the role of microsatellites in treatment decisions for stage II colon cancer, the staging and treatment of rectal cancer, and the management of colorectal and metastatic pancreatic cancers.