1
|
Arantes LH, Crawford J, Gascon P, Latymer M, Launay-Vacher V, Rolland C, Scotte F, Wish J. A quick scoping review of efficacy, safety, economic, and health-related quality-of-life outcomes of short- and long-acting erythropoiesis-stimulating agents in the treatment of chemotherapy-induced anemia and chronic kidney disease anemia. Crit Rev Oncol Hematol 2018; 129:79-90. [PMID: 30097240 DOI: 10.1016/j.critrevonc.2018.06.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 06/13/2018] [Indexed: 12/12/2022] Open
Abstract
Erythropoiesis-stimulating agents (ESAs) are man-made forms of erythropoietin used in the treatment of anemia. This quick-scoping review of systematic literature reviews (SLRs) was conducted to define the clinical, economic, and health-related quality of life (HRQoL) outcomes for short-acting and long-acting ESAs in patients with chronic kidney disease-induced anemia (CKD-IA) and patients with chemotherapy-induced anemia (CIA). Embase, Medline, and the Cochrane Database of Systematic Reviews were searched from their establishment until October 2017. SLRs related to the use of short-acting and long-acting ESAs in the treatment of CIA and CKD-IA were included. Forty-eight studies met the inclusion criteria. The evidence suggests little difference in efficacy, HRQoL, and safety outcomes among ESA types. Cost-effectiveness and market price are likely to become determining factors driving the choice of agent. Comparative studies and costing models accounting for the utilization of biosimilars are needed to establish which ESAs are more cost-effective.
Collapse
Affiliation(s)
| | - Jeffrey Crawford
- Department of Hematology-Oncology, Duke University Medical Center, Durham, NC, USA
| | - Pere Gascon
- Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | | | | | | | - Florian Scotte
- Medical Oncology and Supportive Care Department, Hospital Foch, Suresnes, France
| | - Jay Wish
- Indiana University Health, Indianapolis, IN, USA
| |
Collapse
|
2
|
Obirikorang Y, Obirikorang C, Anto EO, Acheampong E, Batu EN, Macaulary F, Paavire CK, Amankwaa B. Knowledge of bloodless medicine among nurses at the Medical/Surgical Directorate of Komfo Anokye Teaching Hospital, Ghana; a descriptive cross sectional study. BMC Res Notes 2017; 10:747. [PMID: 29258567 PMCID: PMC5735550 DOI: 10.1186/s13104-017-3094-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 12/13/2017] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE This study assessed the knowledge of bloodless medicine (BM) among nurses at the medical and surgical directorate of Komfo Anokye Teaching Hospital. A paper questionnaire was administered to 322 nurses to obtain information on socio-demographic characteristics and knowledge of BM. RESULTS More than half (52.1%) of the nurses were aware of BM. The major source of information on BM was from the internet. Out of the study population, 90.1% knew iron therapy as BM strategy. The largest proportions of the participants (51.2%) had witnessed BM treatment at the medical and surgical directorate with the Tot'hema (44.6%) being the major used drug. Flu-like symptoms (37.0%) and organ damage (50.0%) were the commonly known side effects of BM respectively. Most of the participants (97.5%) knew that doctors request for blood transfusion. The major known reason for demand of BM was religious beliefs (53.7%). Higher percentages (71.9%) of the participants were not aware of bloodless surgery although the few who were aware, had heard of this through an internet search. Participants were generally aware of BM but less knowledgeable of specific components of BM. There is the need for prompt hospital and public health education through workshops and in-service training.
Collapse
Affiliation(s)
- Yaa Obirikorang
- Department of Nursing, Faculty of Health and Allied Sciences, Garden City University College (GCUC), Kenyasi, Kumasi, Ghana
| | - Christian Obirikorang
- Department of Molecular Medicine, School of Medical Science, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Enoch Odame Anto
- Department of Molecular Medicine, School of Medical Science, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana.,Department of Medical Laboratory Technology, Royal Ann College of Health, Atwima Manhyia, Kumasi, Ghana
| | - Emmanuel Acheampong
- Department of Molecular Medicine, School of Medical Science, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana.
| | - Emmanuella Nsenbah Batu
- Department of Nursing, Faculty of Health and Allied Sciences, Garden City University College (GCUC), Kenyasi, Kumasi, Ghana
| | - Flora Macaulary
- Department of Nursing, Faculty of Health and Allied Sciences, Garden City University College (GCUC), Kenyasi, Kumasi, Ghana
| | - Christopher Kwaku Paavire
- Department of Nursing, Faculty of Health and Allied Sciences, Garden City University College (GCUC), Kenyasi, Kumasi, Ghana
| | - Bright Amankwaa
- Department of Molecular Medicine, School of Medical Science, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| |
Collapse
|
3
|
Caggiano V, Tannous RE, Gupta S, Fridman M. Chemotherapy-induced moderate to severe anemia in intermediate-grade non-Hodgkin’s lymphoma patients. J Oncol Pharm Pract 2016. [DOI: 10.1191/1078155202jp091oa] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This study investigated the incidence of anemia in chemotherapy-treated intermediate-grade non-Hodgkin’s lymphoma (IGNHL) patients. A historic case series design was used. The study data were obtained from 12 oncology practices that participated in the Oncology Practice Pattern Study (OPPS). The analysis focused on 353 IGNHL patients with normal baseline (prechemotherapy) hemoglobin (Hb) (≥12.0 g/dL). These patients were treated with CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone combination) therapy (at some point) from 1993 through 1999. Anemia was found to be prominent during chemotherapy. About 24% of the patients with a normal baseline Hb level dropped below 10.0 g/dL and 49% dropped to 10.0 -11.9 g/dL, at some point during chemotherapy. As anemia treatment data were unavailable, it is likely that some of these patients received therapy to boost their Hb levels, rendering our results conservative. A logistic regression model revealed that in patients with normal baseline Hb, age ≥60, female gender, lower baseline Hb level, and lymphoma histology classified as the Working Formulation (WF) E or H were significant predictors of a drop in Hb below 10.0 g/dL during chemotherapy. Chemo-therapy-induced anemia is frequently observed in lymphoma patients. It is possible to identify adverse baseline patient characteristics associated with higher risk of chemotherapy-induced anemia and carefully monitor such patients. Additional studies in community oncology practice are warranted to validate these findings and improve our understanding of the problems of anemia in chemotherapy treated non-Hodgkin’s lymphoma (NHL) patients.
Collapse
Affiliation(s)
- Vincent Caggiano
- Sutter Cancer Center, and Sutter Institute for Medical Research, Sacramento, California
| | | | | | | |
Collapse
|
4
|
Pearce A, Haas M, Viney R, Haywood P, Pearson SA, van Gool K, Srasuebkul P, Ward R. Can administrative data be used to measure chemotherapy side effects? Expert Rev Pharmacoecon Outcomes Res 2014; 15:215-22. [PMID: 25495682 DOI: 10.1586/14737167.2015.990888] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Many of the issues with using data from clinical trials and observational studies for economic evaluations are highlighted in the case of chemotherapy side effects. We present the results of an observational cohort study using linked administrative data. The chemotherapy side effects identified in the administrative data are compared with patient self-reports of such events. The results of these comparisons are then used to guide a discussion of the issues surrounding the use of administrative data to identify clinical events for the population of economic models. Although the advantages of easy access and generalizability of the results make administrative data an attractive option for populating economic models, this is not always possible because of the limitations of these data.
Collapse
Affiliation(s)
- Alison Pearce
- University of Technology, Sydney, Centre for Health Economics Research and Evaluation, PO Box 123, Broadway, Australia
| | | | | | | | | | | | | | | |
Collapse
|
5
|
Braiteh F, Bruera E. Palliative Care in the Management of Cancer Pain. Pain Manag 2011. [DOI: 10.1016/b978-1-4377-0721-2.00039-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
6
|
Abstract
CRF is indisputably a significant problem with important public health and medical economic implications. As the prevalence of cancer survivorship grows, the impact of CRF will increase. Physiatrists have not historically played an active role in caring for affected patients. In the author's opinion, this is unfortunate, since the holistic, integrated, and cross-disciplinary approach that characterizes physiatry seems ideally suited to offer patients meaningful benefit. Physiatrists with a clinical interest are likely to be robustly rewarded with interest from the oncological community, as CRF is a frustrating and devastating problem for patients and clinicians alike.
Collapse
|
7
|
Abstract
Cancer-related fatigue (CRF) is influenced and modulated by a number of critical factors, and the mechanism that is both necessary and sufficient to induce development of severe fatigue in patients with cancer has not yet been identified. Specific research efforts to understand the factors that may contribute to CRF development have been made, including studies of the direct effects of tumor burden, the effects of cancer treatment, and other pathophysiologic and psychosocial conditions. Compelling new hypotheses regarding CRF pathophysiology have been proposed, such as the pro-inflammatory hypothesis, the serotonin hypothesis, the vagal-afferent-activation hypothesis, the anemia hypothesis, and the adenosine triphosphate hypothesis; some of these have been tested in both animal models and humans and some in animals only. Gaining an understanding of the specific mechanisms related to the development of fatigue in patients with cancer and survivors requires further investigation. Pathophysiologic research in CRF could be applied in the clinic to improve CRF diagnosis and to enable administration of mechanism-driven interventions. A targeted intervention study with CRF as a primary end point also would be useful.
Collapse
Affiliation(s)
- Xin Shelley Wang
- Department of Symptom Research, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA.
| |
Collapse
|
8
|
Adelola OA, Ahmed I, Fenton JE. Management of Jehovah's Witnesses in otolaryngology, head and neck surgery. Am J Otolaryngol 2008; 29:270-8. [PMID: 18598840 DOI: 10.1016/j.amjoto.2007.08.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2006] [Revised: 08/09/2007] [Accepted: 08/20/2007] [Indexed: 12/19/2022]
Abstract
It is imperative that surgeons should have some knowledge and understanding of the beliefs of Jehovah's Witnesses to respect the patient's wishes and effectively minimize and manage blood loss. The objective of this review was to provide a management strategy for Jehovah's Witness patients undergoing otolaryngology, head and neck surgery, because there is paucity of information regarding this within our literature. A systematic review of medical literature was conducted. Articles were identified using MEDLINE (1966-2007). The search strategy used Medical Subject Heading terms Jehovah's Witnesses, Beliefs, Ethical and Legal issues, Blood transfusion alternatives, ENT, Head and Neck surgery in Jehovah' witnesses. There is a broad range of nonblood surgical management strategies available in other specialities, making major surgery possible within this population. This review suggests recommendations in elective surgery, trauma, and emergencies.
Collapse
|
9
|
Biesma B, van de Werf PR, Melissant CF, Brok RGPM. Anaemia management with epoetin alfa in lung cancer patients in The Netherlands. Lung Cancer 2007; 58:104-11. [PMID: 17601632 DOI: 10.1016/j.lungcan.2007.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2007] [Revised: 04/30/2007] [Accepted: 05/13/2007] [Indexed: 10/23/2022]
Abstract
Anaemia seriously threatens the quality of life (QOL) in cancer patients receiving chemotherapy. In this article results are presented on the lung cancer population from a Dutch observational study. This study addressed the real-life situation of recombinant human erythropoietin (r-Hu-EPO or epoetin alfa) treatment in anaemic cancer patients receiving chemotherapy, with a focus on efficacy. In total 781 patients were enrolled in the observational study, including 382 patients with lung cancer. At enrolment patients were receiving epoetin alfa treatment and/or patients had a haemoglobin (Hb) level </=11.3g/dl. Analysis was focused on lung cancer patients who were treated with epoetin alfa (n=343). Type of cancer, chemotherapy agents, type of anaemia management and Hb levels were documented. Hb development was analysed and the effect of epoetin alfa treatment was investigated. In total 343 lung cancer patients were treated with epoetin alfa: 210 patients with non-small cell lung cancer (NSCLC) and 133 patients with small cell lung cancer (SCLC). The majority of patients (99.4%) received 40,000 IU epoetin alfa once weekly. Before epoetin alfa treatment was started during chemotherapy, Hb levels decreased with a rate of 1.3g/dl per 4 weeks, both for NSCLC as well as for SCLC. Epoetin alfa treatment was started on average at an Hb level of 10.6g/dl for NSCLC and 10.4g/dl for SCLC, respectively. Hb increases of 0.5-0.6g/dl per 4 weeks and 0.2g/dl per 4 weeks were reached for NSCLC and SCLC, respectively. Although significant increases of Hb levels were reached, the epoetin alfa treatment could not fully correct the Hb decrease which had taken place during chemotherapy before the start of epoetin alfa, resulting in suboptimal Hb levels. In contrast, early intervention with epoetin alfa (start in first week of chemotherapy at Hb>11.3g/dl) was especially effective for NSCLC patients where it resulted in a stabilization of Hb at baseline level. For SCLC patients this strategy was less effective. Furthermore, early intervention seemed to diminish the need for a blood transfusion, i.e., the higher the Hb at epoetin initiation the more patients did not receive any blood transfusion. Results from this observational study demonstrate that epoetin alfa treatment corrects chemotherapy-related anaemia in both NSCLC as well as SCLC patients. Early epoetin alfa intervention seems advantageous for lung cancer patients both in terms of maintaining adequate Hb levels during chemotherapy as well as reducing transfusions.
Collapse
Affiliation(s)
- Bonne Biesma
- Jeroen Bosch Hospital, Department of Pulmonary Diseases, Tolbrugstraat 11, 5211 RW 's-Hertogenbosch, The Netherlands.
| | | | | | | |
Collapse
|
10
|
Aapro M, Abraham I, Bokemeyer C, Ludwig H, Macdonald K, Soubeyran P, Turner M. The background and methodology of the Anaemia Cancer Treatment (A.C.T.) study: a global retrospective study of practice patterns and outcomes in the management of anaemia in cancer patients and their congruence with evidence-based guidelines. Support Care Cancer 2007; 16:193-200. [PMID: 17874142 DOI: 10.1007/s00520-007-0311-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2007] [Accepted: 07/11/2007] [Indexed: 11/30/2022]
Abstract
GOAL The benefit of supportive care with erythropoiesis-stimulating agents (ESAs) for patients with cancer-related anaemia is well known. However, the European Cancer Anaemia Survey (ECAS, data from 2001) showed that about 60% of cancer patients with anaemia do not receive any treatment. Since ECAS, evidence-based guidelines have provided recommendations for ESA use, but it is not known to what extent current treatment patterns follow these guidelines. To address this issue, the Anaemia Cancer Treatment (A.C.T.) study was initiated. The background to the development of the A.C.T. study and study methodology are described. MATERIALS AND METHODS The A.C.T. study is a global, retrospective, pharmacoepidemiologic study of at least 2,560 medical records of anaemic patients with cancer who were previously treated with an ESA from a minimum of 186 centres. Records from patients aged greater than or equal to 18 years with a diagnosis of solid tumour or myeloma or lymphoma and who were started on ESAs 3-12 months before inclusion and followed for 8-10 weeks will be eligible. Factors associated with ESA non-responsiveness will also be evaluated. MAIN RESULTS Completion of the European phase of the study is anticipated in late 2007 with the rest of the world closing in late 2007 or early 2008. Publication of findings is anticipated in 2008. CONCLUSIONS By examining the extent to which anaemia management in clinical practice is congruent with best practice guidelines, the A.C.T. study will provide a further foundation for the development of evidence-based supportive cancer care.
Collapse
Affiliation(s)
- Matti Aapro
- Multidisciplinary Oncology Institute, Genolier, Switzerland.
| | | | | | | | | | | | | |
Collapse
|
11
|
Olson K, Turner AR, Courneya KS, Field C, Man G, Cree M, Hanson J. Possible links between behavioral and physiological indices of tiredness, fatigue, and exhaustion in advanced cancer. Support Care Cancer 2007; 16:241-9. [PMID: 17647028 DOI: 10.1007/s00520-007-0298-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2007] [Accepted: 06/12/2007] [Indexed: 10/23/2022]
Abstract
GOALS In this theoretical paper, we present the Edmonton Fatigue Framework (EFF), a new framework for the study of tiredness, fatigue, and exhaustion in advanced cancer. MATERIALS AND METHODS The Fatigue Adaptation Model (FAM), the starting point for the EFF, was drawn from a literature review pertaining to fatigue in depression, chronic fatigue syndrome, cancer, shift workers, and athletes published in the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medical Literature Analysis and Retrieval System Online (MEDLINE), PubMed, PsychINFO, SPORTdiscus, and CancerLit between 1995 and 2004, and from seven qualitative studies conducted by our group. The EFF, an elaboration of the FAM, was constructed after an expansion of our literature review to 2006 and team discussion. The EFF provides new insights into possible links between behavioral and physiological indices of tiredness, fatigue, and exhaustion as they occur in both ill and non-ill states. In this paper, however, we consider only possible links in advanced cancer. CONCLUSIONS We propose that stressors associated with advanced cancer and its supportive treatment trigger declines in four systems -- cognitive function, sleep quality, nutrition, and muscle endurance -- and that these declines reduce one's ability to adapt. While these systems each likely has its own effect on adaptation, we propose that the most important and serious effects arise from interactions among declines in cognitive function, sleep quality, nutrition, and muscle endurance. CONCLUSIONS Interventions for fatigue have been limited by a lack of understanding about its etiology. Hypotheses arising from the EFF; suggest a new direction for further study that focuses on interactions among cognitive function, sleep quality, nutrition, and muscle endurance.
Collapse
Affiliation(s)
- Karin Olson
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.
| | | | | | | | | | | | | |
Collapse
|
12
|
Labourey JL. Place de l'activité physique dans la prise en charge de la fatigue cancéreuse induite par les traitements oncologiques. ACTA ACUST UNITED AC 2007. [DOI: 10.1016/j.annrmp.2007.03.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
13
|
Labourey JL. Physical activity in the management of cancer-related fatigue induced by oncological treatments. ACTA ACUST UNITED AC 2007; 50:450-4, 445-9. [PMID: 17399841 DOI: 10.1016/j.annrmp.2007.03.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2007] [Accepted: 03/08/2007] [Indexed: 12/31/2022]
Abstract
OBJECTIVE We aimed to review the literature on physical activity in the management of cancer-related fatigue. MATERIALS AND METHODS A search of PubMed for English- or French-language articles using the keywords fatigue, cancer, exercise, physical activity, sport, randomized, and controlled. RESULTS We found reports of 11 randomized or controlled studies, all of them in English. Most involved small numbers of patients. Four of the studies reported that physical exercise had an effect on the fatigue: three a positive effect and one a negative effect. One of these four studies was carried out in patients still undergoing treatment (hormone therapy). Of the three post-treatment studies, the two finding positive effect involved breast cancer patients quite a while after the end of treatment (chemotherapy and/or radiotherapy), whereas the study finding a negative effect involved patients 1 month after treatment, all with chemotherapy. CONCLUSION Physical activity appears to be a good way of combating fatigue induced by various cancer therapies. However, many questions remain, which highlights the need for randomized studies with sufficient numbers of patients.
Collapse
Affiliation(s)
- J L Labourey
- Service d'oncologie médicale [Medical Oncology Department], CHU Dupuytren [Dupuytren Teaching Hospital], 2, avenue Martin-Luther-King, 87042 Limoges cedex, France.
| |
Collapse
|
14
|
Braiteh F, Bruera E. Palliative Care in the Management of Cancer Pain. Pain Manag 2007. [DOI: 10.1016/b978-0-7216-0334-6.50039-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
|
15
|
Reineke-Bracke H, Radbruch L, Elsner F. Treatment of fatigue: modafinil, methylphenidate, and goals of care. J Palliat Med 2006; 9:1210-4. [PMID: 17040162 DOI: 10.1089/jpm.2006.9.1210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
16
|
Del Fabbro E, Dalal S, Bruera E. Symptom control in palliative care--Part II: cachexia/anorexia and fatigue. J Palliat Med 2006; 9:409-21. [PMID: 16629571 DOI: 10.1089/jpm.2006.9.409] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Egidio Del Fabbro
- Department of Palliative Care and Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston, 77030, USA
| | | | | |
Collapse
|
17
|
Nieboer P, Buijs C, Rodenhuis S, Seynaeve C, Beex LVAM, van der Wall E, Richel DJ, Nooij MA, Voest EE, Hupperets P, Mulder NH, van der Graaf WTA, TenVergert EM, van Tinteren H, de Vries EGE. Fatigue and Relating Factors in High-Risk Breast Cancer Patients Treated With Adjuvant Standard or High-Dose Chemotherapy: A Longitudinal Study. J Clin Oncol 2005; 23:8296-304. [PMID: 16219926 DOI: 10.1200/jco.2005.10.167] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PurposeDetermine whether standard or high-dose chemotherapy leads to changes in fatigue, hemoglobin (Hb), mental health, muscle and joint pain, and menopausal status from pre- to post-treatment and to evaluate whether fatigue is associated with these factors in disease-free breast cancer patients.Patients and MethodsEight hundred eighty-five patients were randomly assigned between two chemotherapy regimens both followed by radiotherapy and tamoxifen. Fatigue was assessed using vitality scale (score ≤ 46 defined as fatigue), poor mental health using mental health scale (score ≤ 56 defined as poor mental health) both of Short-Form 36, muscle and joint pain with Rotterdam Symptom Checklist, and Hb levels were assessed before and 1, 2, and 3 years after chemotherapy.ResultsFatigue was reported in 20% of 430 assessable patients (202 standard-dose, 228 high-dose) with at least a 3-year follow-up, without change over time or difference between treatment arms. Mean Hb levels were lower following high-dose chemotherapy. Only 5% of patients experienced fatigue and anemia. Mental health score was the strongest fatigue predictor at all assessment moments. Menopausal status had no effect on fatigue. Linear mixed effect models showed that the higher the Hb level (P = .0006) and mental health score (P < .0001), the less fatigue was experienced. Joint (P < .0001) and muscle pain (P = .0283) were associated with more fatigue.ConclusionIn 3 years after treatment, no significant differences in fatigue were found between standard and high-dose chemotherapy. Fatigue did not change over time. The strongest fatigue predictor was poor mental health.
Collapse
Affiliation(s)
- Peter Nieboer
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Engert A. Recombinant human erythropoietin in oncology: current status and further developments. Ann Oncol 2005; 16:1584-95. [PMID: 15958437 DOI: 10.1093/annonc/mdi307] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Anaemia effects up to 90% of cancer patients, with more than 60% requiring blood transfusion during or after treatment. With the advent of recombinant human erythropoietins (rHuEPO), an alternative to red blood cell transfusion has become available. So far, three drugs have been approved for the treatment of anaemia in patients with malignancies (epoetin alfa, epoetin beta and darbepoetin alfa). New concepts for the use of erythropoietin in cancer patients include 3- and 4-weekly dosing, as well as loading-dose concepts. Important factors helping to judge the impact of erythropoietin in cancer treatment include pharmacoeconomics and better predictive factors. Lately, the influence of erythropoietin therapy on survival in cancer patients has been discussed very intensively, because conflicting data have emerged. Studies aimed at correcting anaemia in cancer patients had indicated a possible survival advantage of those patients receiving erythropoietin. In contrast, two recent trials aimed at correction of haemoglobin levels beyond anaemia reported a poorer survival of patients receiving erythropoietin. This might grossly be attributed to a higher risk of thrombosis in these patients. The largest systematic review on the use of erythropoietin in cancer patients undergoing treatment indicates a suggestive but not significant survival advantage of erythropoietin-treated patients. In addition, very recent results of a Food and Drug Administration meeting on safety and survival of patients treated with erythropoietin are presented.
Collapse
Affiliation(s)
- A Engert
- Klinik I für Innere Medizin, Universitätsklinikum Köln, Köln, Germany.
| |
Collapse
|
19
|
|
20
|
Witzig TE, Silberstein PT, Loprinzi CL, Sloan JA, Novotny PJ, Mailliard JA, Rowland KM, Alberts SR, Krook JE, Levitt R, Morton RF. Phase III, randomized, double-blind study of epoetin alfa compared with placebo in anemic patients receiving chemotherapy. J Clin Oncol 2004; 23:2606-17. [PMID: 15452187 DOI: 10.1200/jco.2004.10.020] [Citation(s) in RCA: 177] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To determine whether weekly epoetin alfa could improve hemoglobin (HgB) levels, reduce RBC transfusions, and improve quality of life (QOL) in patients with advanced cancer and with anemia after receiving myelosuppressive chemotherapy. PATIENTS AND METHODS This double-blind, placebo-controlled study randomly assigned patients to placebo or epoetin alfa (Ortho Biotech, Bridgewater, NJ) 40,000 U subcutaneous weekly for 16 weeks. QOL, HgB, and RBC transfusions were measured pretreatment and monthly. RESULTS The study accrued 344 patients; 330 were assessable for efficacy and 305 were assessable for QOL. Placebo-treated patients had a mean increase in HgB of 0.9 g/dL (range, -3.8 to +5.3) compared with 2.8 g/dL (range, -2.2 to +7.5) for epoetin-treated patients (P < .0001). During the study, 31.7% of placebo-treated patients achieved a > or = 2 g/dL HgB increase compared with 72.7% of epoetin-treated patients (P < .0001). The incidence of RBC transfusion for placebo and epoetin treatment arms was 39.6% and 25.3% (P = .005), respectively. The placebo group received 256 units of RBCs compared with 127 units in the epoetin group (P < .0001). The incidence of toxicity in the groups was similar. Changes in the average QOL scores from baseline to the end of the study were similar in the two groups (P = not significant). The HgB responders (irrespective of treatment arm) had a mean change in Functional Assessment of Cancer Therapy (FACT) fatigue score from a baseline of +5.1 compared with -2.1 for the nonresponders (P = .006). CONCLUSION Epoetin alfa significantly improved HgB and reduced transfusions in this patient population. These results support the use of weekly epoetin alfa as an ameliorative agent for cancer-related anemia.
Collapse
Affiliation(s)
- Thomas E Witzig
- Department of Hematology and Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Ferrario E, Ferrari L, Bidoli P, De Candis D, Del Vecchio M, De Dosso S, Buzzoni R, Bajetta E. Treatment of cancer-related anemia with epoetin alfa: a review. Cancer Treat Rev 2004; 30:563-75. [PMID: 15325036 DOI: 10.1016/j.ctrv.2004.04.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Erythropoietin (EPO) is a hematopoietic growth hormone that regulates survival, proliferation, and differentiation of erythroid progenitor cells. A reduction in tissue oxygenation stimulates EPO production, through a complex feedback mechanism. Patients with cancer-related anemia have an inadequate EPO response that is further impaired by cancer treatments such as chemotherapy. Cancer-related anemia substantially impairs patient functioning and may contribute to poor treatment outcomes. A significant number of studies demonstrates that treatment of anemia in cancer patients using recombinant human EPO (rHuEPO, epoetin alfa) significantly increases haemoglobin (Hb) levels, reduces transfusion requirements, and improves quality of life, particularly by relieving fatigue. Recent data also show that epoetin alfa therapy may improve cognitive function in patients receiving chemotherapy. In addition, the correction of anemia may prolong survival by enhancing tumor oxygenation, thus increasing tumor sensitivity to chemotherapy or radiation. The indicated dose of epoetin alfa is 150-300 IU/kg three times per week, but it is commonly dosed at 40,000-60,000 IU once weekly based on trial data and extensive clinical use. Determining the timing of initiation of epoetin alfa is a clinical judgement; however, data suggest that patient functioning declines and the risk of transfusion increases when the Hb level falls under 12 g/dL.
Collapse
Affiliation(s)
- Erminia Ferrario
- Medical Oncology Unit B, Istituto Nazionale per lo Studio e la Cura dei Tumori, Via Venezian 1, 20133 Milan, Italy
| | | | | | | | | | | | | | | |
Collapse
|
22
|
Kirshner J, Hatch M, Hennessy DD, Fridman M, Tannous RE. Anemia in stage II and III breast cancer patients treated with adjuvant doxorubicin and cyclophosphamide chemotherapy. Oncologist 2004; 9:25-32. [PMID: 14755012 DOI: 10.1634/theoncologist.9-1-25] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE The incidence and severity of prechemotherapy anemia and chemotherapy-induced anemia experienced by women treated with adjuvant doxorubicin and cyclophosphamide (AC) therapy for stage II and III breast cancer are described. PATIENTS AND METHODS Medical charts of 310 breast cancer patients who received chemotherapy at eight oncology practices during 1997 through 2001 were reviewed in this historical case series study. Prechemotherapy anemia was defined as a baseline hemoglobin value <12 g/dl. An anemic event during chemotherapy (used to define chemotherapy-induced anemia) was defined as either a drop in hemoglobin level below the threshold (< or = 10 g/dl), the receipt of a blood transfusion(s), or treatment with epoetin alfa. RESULTS Overall, 40.0% of patients experienced moderate to severe anemia (i.e., their hemoglobin levels dropped to <10 g/dl) and 31.3% (97/310) were anemic prechemotherapy. Of the patients with mild anemia prechemotherapy, 61.9% developed moderate to severe anemia during chemotherapy. Only 47.4% (46/97) of those patients received epoetin alfa therapy during chemotherapy. Of the patients with normal prechemotherapy hemoglobin levels (> or = 12 g/dl), 88.3% developed some degree of anemia (<12 g/dl) during chemotherapy and 27.7% (59/213) developed moderate to severe anemia (<10 g/dl). Anemic events were experienced by 41.8% (89/213) of the patients with normal prechemotherapy hemoglobin levels. CONCLUSIONS We conclude that a significant proportion (31.3%) of stage II and III breast cancer patients are anemic prechemotherapy and that the incidence of anemia increases substantially from prechemotherapy through the postchemotherapy period. This evidence appears to warrant earlier evaluation of anemia and an intervention in the prechemotherapy stage.
Collapse
Affiliation(s)
- Jeffrey Kirshner
- Hematology-Oncology Associates of Central New York, East Syracuse, New York 13057, USA.
| | | | | | | | | |
Collapse
|
23
|
Wratten C, Kilmurray J, Nash S, Seldon M, Hamilton CS, O'Brien PC, Denham JW. Fatigue during breast radiotherapy and its relationship to biological factors. Int J Radiat Oncol Biol Phys 2004; 59:160-7. [PMID: 15093912 DOI: 10.1016/j.ijrobp.2003.10.008] [Citation(s) in RCA: 113] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2003] [Revised: 09/24/2003] [Accepted: 10/15/2003] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Fatigue is commonly reported in patients receiving radiotherapy for breast conservation, but the underlying mechanisms remain unclear. METHODS Patients with early breast cancer participating in a prospective study of the impact of inflammatory processes on early and delayed breast morbidity were assessed for fatigue levels using the Functional Assessment of Cancer Therapy (FACT) fatigue subscale before and at intervals during and after radiotherapy. Blood for analysis of a variety of circulating cytokines, coagulation factors, peripheral blood indices and biochemical factors was collected at the same time points. RESULTS Fifty-two eligible patients were assessed. Twenty-one patients (43%) developed significant fatigue during radiotherapy, whereas 28 (54%) developed minimal or no fatigue. Fatigue appeared to plateau between week 4 of treatment and 2 weeks after treatment. The fatigue was beginning to settle by 6 weeks after treatment. Significant fatigue was predicted by a higher baseline fatigue score, red cell count, neutrophil count, and D-dimer level. Baseline fatigue correlated with higher body mass index, C-reactive protein, soluble thrombomodulin, tissue plasminogen activator, von Willebrand factor antigen, interleukin-6, ICAM-1, hemoglobin and red cell, monocyte, and neutrophil counts. There were also significant correlations between body mass index and tissue plasminogen activator, C-reactive protein, interleukin-6, ICAM-1, and red cell count. After these factors were controlled for, baseline fatigue was seen to be associated with higher body mass index, soluble thrombomodulin, tissue plasminogen activator, von Willebrand factor antigen, monocyte count, and neutrophil count. Multiple logistic regression procedures indicated that the most predictive factors for fatigue during radiotherapy were higher baseline fatigue level and higher baseline neutrophil and red cell counts. CONCLUSION This study has shown that significant fatigue is common in patients receiving breast irradiation and is precipitated during radiotherapy in some patients but not others. The factors shown to be associated with fatigue in this study will be helpful in shaping future studies.
Collapse
Affiliation(s)
- Christopher Wratten
- Department ofRadiation Oncology, Newcastle Mater Misericordiae Hospital, Waratah, NSW, Australia.
| | | | | | | | | | | | | |
Collapse
|
24
|
Abstract
Anaemia develops in most patients undergoing cancer therapy and invariably induces fatigue, which is a major determinant of QOL. Blood transfusions are reserved for patients with severe anaemia, since blood is a scarce resource and provides a short-lived benefit. Epoetins are recombinant proteins capable of alleviating therapy-related anaemia in 40-60% of cancer patients. The number of patients needed to be treated with epoetins to avoid the transfusion of one unit of blood ranges from 2.6 to 5.2; however, the absolute risk reduction depends on patients' characteristics and dose-escalation. The ratio between acquisition costs of epoetins and blood transfusion requirement is very high; thus, many thousands of dollars needs to be spent on epoetins to save 1 blood unit. Despite this, epoetins have been widely adopted by industrialised countries, where cancer patients are about 2% of the total population. The resulting budget impact of epoetins can be calculated at about 10% of the overall direct cost for cancer care, and it is expected to continue growing by about 20% each year, due to the expanding cancer population and the intensification of cancer therapies. The economic burden of epoetins needs to be weighed against the improvement of patients' QOL and society's willingness to pay for a non-life-saving therapy. All published economic evaluations of epoetins invariably report that this supportive therapy is not cost effective. Society should be made aware of the opportunity cost of treatments and should be allowed to elicit preferences for healthcare interventions and prioritisation criteria. In the near future we expect that a wider range of epoetins, drug patent expiry, a more appropriate patient selection criteria and an improved dosage schedule may help increase the efficiency of cancer-related anaemia management.
Collapse
Affiliation(s)
- Monia Marchetti
- Laboratory of Medical Informatics, IRCCS Policlinico San Matteo, Pavia, Italy.
| | | |
Collapse
|
25
|
Bruera E, Driver L, Barnes EA, Willey J, Shen L, Palmer JL, Escalante C. Patient-Controlled Methylphenidate for the Management of Fatigue in Patients With Advanced Cancer: A Preliminary Report. J Clin Oncol 2003; 21:4439-43. [PMID: 14645434 DOI: 10.1200/jco.2003.06.156] [Citation(s) in RCA: 169] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose: To assess the effects of patient-controlled methylphenidate for cancer-related fatigue. Patients and Methods: In this prospective open study, 31 patients with advanced cancer and fatigue who scored ≥ 4 on a scale of 0 to 10 received methylphenidate 5 mg by mouth every 2 hours as needed for 7 days (maximum, 20 mg/d). Multiple symptoms were assessed daily; the primary end point, fatigue, was measured using the 0 to 10 scale, and the Functional Assessment for Chronic Illness Therapy–Fatigue (FACIT-F) was performed at baseline, day 7, and day 28. Results: The following mean (± standard deviation) scores for 30 assessable patients improved significantly between baseline and day 7: fatigue (0 to 10 scale), 7.2 ± 1.6 v 3.0 ± 1.9 (P < .001); overall well-being (0 to 10 scale), 4.5 ± 2.2 v 2.8 ± 2.1 (P < .001); fatigue (FACIT-F) subscore, 17.5 ± 11.3 v 34.7 ± 10.0 (P < .001); functional well-being, 14.4 ± 5.9 v 18.3 ± 6.6 (P < .001); and physical well-being, 13.5 ± 6.4 v 21.4 ± 5.0 (P < .001). Anxiety, appetite, pain, nausea, depression, and drowsiness all improved significantly (P < .05). All patients took afternoon or evening doses, and 28 patients (93%) took three or more doses daily. All patients chose to continue taking methylphenidate after 7 days of treatment. No serious side effects were reported. Conclusion: These preliminary results suggest that patient-controlled methylphenidate administration rapidly improved fatigue and other symptoms. Randomized controlled trials are justified.
Collapse
Affiliation(s)
- Eduardo Bruera
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas M.D. Anderson Cancer Center, Unit 8, 1515 Holcombe Blvd, Houston, TX 77030, USA.
| | | | | | | | | | | | | |
Collapse
|
26
|
Cella D, Dobrez D, Glaspy J. Control of cancer-related anemia with erythropoietic agents: a review of evidence for improved quality of life and clinical outcomes. Ann Oncol 2003; 14:511-9. [PMID: 12649095 DOI: 10.1093/annonc/mdg167] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Anemia occurs frequently in patients with cancer and is associated with impaired health-related quality of life (HRQOL). Treatment of anemia results in significant improvements in energy, activity and overall HRQOL, particularly among patients with mild-to-moderate anemia. Importantly, studies have indicated that anemia may have a negative impact on the success of radiotherapy, reducing survival and locoregional control. Recent preclinical and preliminary clinical data have also suggested that anemia may be associated with poorer outcomes following chemotherapy or surgery. MATERIALS AND METHODS Data for review were identified and selected from searches of the literature published from January 1990 through to October 2002 using Medline, and searches of proceedings from key international oncology and hematology meetings. RESULTS A wealth of data indicate that treatment of anemia improves HRQOL in patients with cancer. Prospective studies exploring survival and/or treatment outcomes in anemic cancer patients are currently in their early stages, preventing any firm conclusions from being drawn, although they do indicate a benefit in treating anemia. CONCLUSIONS Recent studies support the use of erythropoietic agents in anemic cancer patients as a means of raising their hemoglobin levels and consequently improving their HRQOL. Randomized, controlled trials are needed to determine whether treating anemia with erythropoietic agents will improve other outcomes following therapy.
Collapse
Affiliation(s)
- D Cella
- Institute for Health Services Research and Policy Studies, Northwestern University, Evanston, IL, USA.
| | | | | |
Collapse
|
27
|
Van Belle S. The Role of Erythropoietin in the Supportive Care of Breast Cancer. Breast Cancer Res Treat 2003. [DOI: 10.1023/a:1026385227074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
28
|
Abstract
Fatigue is the most common symptom in patients with advanced cancer. It is a subjective sensation with physical, cognitive, and affective modes of expression. The etiology is often unclear, and multiple potential etiologic factors for fatigue may coexist. Assessing fatigue involves characterizing its severity, temporal features, exacerbating and relieving factors, associated distress, and impact on daily life. Potential factors contributing to fatigue are the cancer itself, cancer treatment, cancer or treatment complications, medications, and other physical and psychosocial conditions. Many fatigue assessment tools exist. Fatigue management involves specific (targeting potentially reversible causes of fatigue) and symptomatic (targeting symptoms because no obvious etiology or reversible cause for fatigue can be identified) intervention and treatment measures. Specific interventions include treating anemia or metabolic and endocrine abnormalities, as well as managing pain, insomnia, depression, and anxiety. Symptomatic treatment involves education, counseling, and pharmacologic, and nonpharmacologic measures. Pharmacologic agents that have been investigated for use in treating fatigue include corticosteroids, progestational agents, and psychostimulants. Agents that modulate cytokine activity are future treatment possibilities.
Collapse
Affiliation(s)
- E A Barnes
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas M D Anderson Cancer Center, Houston, Texas 77030, USA
| | | |
Collapse
|